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THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 

PRICK Sl.OO PER YEAR 



Contributions invited from the Alumni of the University 
Business Address, Baltimore, M 




atered at the Baltimore Post : office 
as Second Class Matte/. , 



VOL. V 



BALTIMORE, MD., MARCH 15, 1909 



j rf-Vfl* 



No. 1 



LAENNEC. 

An Address delivered before the Nu Sigma Xit 
Fraternity, February 20, 1909, 

By Samuel C. Chew, M. D., LL. D., 

Professor of Medicine in the University of 

Maryland. 

Among the most pleasant recollections of my 
past professional life is the thought that I was 
one of the first to extend a cordial greeting and 
welcome to our friend and colleague, then a 
newly arrived stranger here, now and for many 
years past a most cherished member of our own 
household, in whose honor we are gathered to- 
gether tonight — Professor William H. Welch. 
It was at the house of a mutual friend who was 
also, if I mistake not, a classmate of Dr. Welch 
at Yale University ; and then began a friendship 
and a regard which have continually grown in 
my feeling towards him with the lapse of time — 
a friendship which I shall always account a priv- 
ilege and a pleasure, a regard which will only in- 
crease with increasing years. 

I have been asked to respond on this occasion 
to the sentiment of the name and labors of Laen- 
nec, and it is not difficult to find a connecting 
link between the work of so eminent a patholo- 
gist as Professor Welch and that of the founder 
of the science of auscultatory diagnosis. For it 
must be kept in mind that accurate diagnosis of 
affections of the lungs and heart rests perhaps 
more immediately upon, and is determined by a 
knowledge of pathological changes in those or- 
gans, it is attained with greater precision and 
greater promptitude with the possession of such 
knowledge, than is the case with many other, or, 
perhaps, I may say, any other organic diseases 
of equal gravity. The special value, indeed, of 
the method of auscultatory diagnosis is found 
in the certainty of the conclusions which it 
reaches in difficult and complicated cases, so that 
it may be said without exaggeration that it is as 



powerful a solvent of previously insoluble prob- 
lems as the calculus is in mathematics. 

It seems strange, indeed, that in Laennec's own 
time one objection urged against auscultation 
was that it attempted to raise medicine to the 
rank of an exact science and place it by the side 
of mathematics and astronomy. 

And this also. I think, may be said, that in the 
entire range of all branches of knowledge there is 
not a more remarkable instance of profundity of 
thought, of the power of penetrating to the deep 
and hidden unknown and bringing it into the 
light, than is afforded by that science of auscul- 
tation which sprang almost perfect and com- 
plete — and there is the wonder of it — from the 
brain of one man, from the brilliant genius of 
Laennec. And this claim to originality in behalf 
of Laennec may surely be made without forget- 
fulness of the fact that in the early dawn of 
scientific medicine Hippocrates used the sense of 
hearing in the diagnosis of thoracic dis- 
ease; nor of the further facts that many cen- 
turies later Auenbrugger practiced percussion ; 
and that still later Corvisart made use of this 
means to some extent. Hut the method did not 
in the hands of any of these physicians serve the 
purpose of establishing certainty of diagnosis. 
That which Laennec accomplished was the crea- 
tion of a science which converted previously un- 
heard, unheeded and confused sounds into an 
articulate language, speaking with logical pre- 
cision and conveying truth with the certainty of 
mathematical demonstration. It was said by the 
eminent pathologist, Rokitansky, that "had Laen- 
nec done nothing else for medical science, his 
discovery of emphysema and of the causes giving 
rise to it would have been sufficient to render his 
name immortal." But, important as this contri- 
bution to medical knowledge was, it was a small 
and very limited part of Laennec's great achieve- 
ments. 

Just ninety-four years ago, in February. 1815, 
Laennec communicated to the Sonde de I'Fcole 



THE HOSPITAL BULLETIN 



his first results in auscultatory diagnosis. On 
the 30th of April following he submitted another 
treatise on the same subject to the same body, 
and on May 14th — an illustrious day in the his- 
tory of medicine — he made his first essay with 
the stethoscope. April and May, 1815 — memor- 
able months for far different reasons of a most 
memorable year. Consider the contrast between 
the events of the outside world at this time, when 
the embattled armies of Europe were being mar- 
shaled for the tremendous struggle, which in a 
few weeks found its close in the carnage of 
Waterloo, and on the other hand the work of the 
quiet student going on at the same time within 
the wards of the Beaujon and Keeker hos- 
pitals, earnest in his labors, constant in his duties, 
devout, as we are told he was, in his religious 
faith, strict in his adherence to the Catholic 
Church of his country, and bent upon the acqui- 
sition of knowledge which should lessen human 
suffering and save multitudes of human lives. 
And yet, outside of our own profession, how few 
there are who have known even the name of that 
great benefactor of humanity. 

"Of two such lessons why forget 
The nobler and the better one ?' 

Consider the contrast. May it not be likened 
to the difference between the confusion, turmoil 
and strife of "the corrupted currents of this 
world" and those blessed ministrations of good 
which may engage the serene and beneficent in- 
telligencies beyond the veil ? 

Throughout the whole civilized world 
there are few persons who have not at 
some time, and many of them many times, re- 
ceived the boon of health or the boon of life 
from knowledge contributed to mankind by the 
untiring labor, the devotion to duty and the 
splendid genius of Rene Theodore Laennec. 

The work of Laennec placed the pathology and 
diagnosis of thoracic diseases upon a basis of 
certainty, and was thus of vast importance in 
preparing the way for their rational treatment ; 
for scientific therapeutics must always be guided 
by a knowledge of the nature of disease and the 
determination of its exact situation and stage. 

In discussing the question whether direct inoc- 
culation can cause the development of tubercu- 
lous disease, Laennec said that on this subject he 
had but a single fact to adduce, adding that 
though a single fact may prove little, it ought 



to be stated. The fact to which he referred was 
presented in his own case, and it was this, that in 
examining some tuberculous vertebrae he slight- 
ly grazed with the saw the forefinger of his left 
hand, with the result that a small tumor was by 
degrees formed in the place containing a yellow 
body precisely resembling a crude tubercule. 

This infection may have caused the pulmonary 
tuberculosis of which he ultimately died, a vic- 
tim, it may be, of his earnest quest of knowledge 
and a victim, too, of that malady upon the nature 
of which he had himself shed such abundant 
light. 



REPORT OF A CASE OF INTESTINAL 

OBSTRUCTION COMPLICATING 

ACUTE APPENDICITIS. 

By C. F. Strosxidek, '09, 
Senior Medical Student. 

Name, Robt. "Washington; race, black; age, 
20 years ; civil status, single ; occupation, la- 
borer; date entered, August 10, 1908; date dis- 
charged. September 5, 1908. 

Diagnosis. — Intestinal obstruction compli- 
cating acute appendicitis (high post coecal). 

Complaint. — Constipation and pains in abdo- 
men ; family history, father and mother living 
and well ; no brothers or sisters in family. 
Family history negative as to tuberculosis, 
rheumatism, gout, haemophilia and insanity. 

Past History. — Born naturally; was healthy 
as a child, having during childhood whooping- 
cough, measles and chicken pax, but negative 
as to sequelae. Teething normal ; walked at 
age of one year; always healthy until present 
illness. 

Habits. — Smokes moderately, eats heartily 
and fairly regularly. Does not chew tobacco. 
Drinks beer or gin occasionally. Drinks three 
cups of coffee daily. Keeps late hours at night. 

History of Present Illness. — Was taken sick 
on August 10, 1908 (Wednesday), about 2.30 
P. M., whilst driving a cart, with nausea, vom- 
iting, severe abdominal pains, which were gen- 
eral, accompanied by a diarrhoea, the stools 
being greenish in color and at first copious in 
amount. 

Each attack was accompanied with severe 
headache. Such attacks lasted for about fifteen 
minutes, gradually subsiding, until the pain 
and other symptoms would be gone for a 



THE HOSPITAL BULLETIN 



period of about fifteen minutes. About six 
o'clock his bowel movements did not accom- 
pany the attacks, and pain began to radiate 
over the right side of the chest from the region 
of the gall bladder to a point under the right 
scapula and shoulder ; also with shooting pains 
radiating down the back and terminating in 
the glans penis. 

A physician was called in and diagnosed the 
case as one of "cramp colic," and treated the 
same as such. Pain was relieved, but he con- 
tinued to be nauseated and constipated. On 
Saturday evening his pains returned and the 
abdomen began to become distended, which 
gradually grew worse until Sunday morning, 
August 14, when he was sent to the hospital. 
Upon arrival he was found to be suffering 
with excruciating pain, and was very restless, 
the abdomen being greatly swollen and of 
boardlike hardness. He had been able to re- 
tain but very little food since the attack began. 
His temperature registered 104° F., pulse 140, 
respiration 40. 

Physical examination developed the fol- 
lowing: 

General Condition. — The patient lay on his 
back, with rather difficult breathing, being 
restless and anxious. Was well nourished 
weighing 150 pounds. 

Skin. — Black, tight, with plenty of sub-cuta- 
neous fat ; no eruptions ; rather hot and moist ; 
heavy suit of hair; nails rather blue. 

Digestion. — Teeth in excellent condition, 
mucous membrane and lips of mouth appeared 
dry and rather congested ; tongue was covered 
with thick white coat and protruded without 
tremor; swallowed normally; no tracheal tug; 
stomach was unable to retain food on account 
of nausea and vomiting, which vomit contained 
bile. 

Abdomen. — Muscles were boardlike in rigid- 
ity; no abdominal movement was perceptible 
during respiration, as the muscles were fixed. 

Tenderness. — Maximum point was on right 
side from gall bladder area to McBurney's 
point. No enlargement of the gall bladder or 
appendical abscess could be made out by pal- 
pation, but dulness could be elicited by percus- 
sion on the right side to the right of the rectus 
muscle ; otherwise the belly was tympanitic. 

Vascular System. — The heart sounds, its 
size and position were normal. Pulse rate 140 



per minute, regular in force and rhythm, good 
volume and compressible, high tension. 

Respiration. — Breathing rapid (40 per 
minute), rather shallow and expiration pro- 
longed, owing to abdominal muscle fixation. 

Nervous System. — Had anxious expression, 
severe headache and appearance of suffering 
great pain ; very restless, thirsty and begging 
for relief; special senses were negative; could 
not test motor areas for faulty gait or diseased 
joints on account of condition ; tactile, pain, 
heat and cold and muscular senses were nor- 
mal ; reflexes normal ; generative organs ap- 
peared to be normal. 

Microscopically. — Sputum was negative. 

Blood. — Leucocyte count was 12,000 per C. 
M. ; haemoglobin 80 per cent. 

Tertian malaria parasites were present in 
small numbers. 

Urine. — Catheterized specimen of 500 c. c. ; 
acid in reaction, sp. gr. 1032; slight ring of al- 
bumen in Heller's test; sugar negative; Indi- 
can was present in excess. 

Cells. — Few kidney cells and bladder cells 
present ; few hyaline casts and a small amount 
of mucus. Highly colored by indican. 

I completed history at 12.30 P. M. and gave 
the above mentioned diagnosis. Patient was 
taken to operating room at 1 P. M. 

Operation — Anaesthetic Ether. — Anaesthet- 
ist. Dr. J. D. Kerr; surgeon, Dr. R. B. Seem; 
assistant, the writer. Duration of operation, 
one hour. 

A vertical incision was made four inches in 
length along the outer margin of the right 
rectus muscle, the fascia muscle being pushed 
in towards the mid line, the posterior fascia 
and peritoneum were picked up, respectively, 
and cut, the latter being caught by forceps and 
incision completed. Superficial skin and fascia 
vessels were clamped and tied and deep ab- 
dominal retractors put in desired location and 
traction made. On inspection the omentum 
was found to be tied down to the caecum and 
ascending colon, and the small intestines were 
greatly distended with gas. Upon walling off 
the intestines with a Boston pack the omentum 
was released at the highest point, and a pocket 
of pus was discovered, which extended from 
the base of the appendix to under the right 
margin of liver; about one pint of pus was 
mopped from this pocket. Appendix was four 



THE HOSPITAL BULLETIN 



and one-half inches long, being located post- 
caecally (high) and tied down by adhesions, 
and ruptured and gangrenous at the distal 
three inches. Adhesions were broken up and 
appendix freed with great difficulty. It was 
clamped, tied off, a pucker string put around 
the stump, carbolic acid and alcohol used on 
stump, which was turned into caecum, when 
the drawstring was tied and a row of sutures 
put over the same, drawing peritoneum to- 
gether over it. The omentum was found to 
be thrombosed to the extent of about 2^3 
inches, which was tied off and amputated. 

Intestinal Obstruction. — At a point three 
inches from the ileocaecal valve a small band 
about the size of a shoe lace was found to 
constrict the ileum, causing absolute obstruc- 
tion of the intestine. This band did not en- 
circle the intestine entirely, but extended 
across it from side to side. No cause could be 
given for its presence. It was tied off with fine 
silk and clipped with scissors, thus removing 
the obstruction. No other cause of obstruction 
could be located by a further examination of 
the intestinal tract, and drainage was provided 
for by placing a long cigarette drain in the 
pelvic cavity, another under the liver and a 
third one at the base of the appendix. 

The incision was then closed between the 
upper and lower drains, the peritoneum, 
fascias and skin, respectively, with interrupted 
sutures of catgut (20-day chromized) ; wound 
was dressed with gauze, cotton and bandage. 

Patient was returned to ward in a shocked 
condition. Temperature, 103^; pulse, 150; 
respiration. 36. Pulse was weak and small in 
volume and irregular in force and rhythm; ex- 
tremities were cold and clammy. Patient's 
stomach was washed out with warm water. 
Hot blankets and water bottles were applied to 
the extremities and the foot of the bed elevated 
until the shock had been overcome. 

Hypodermodysis of 800 c. c. normal salt 
solution was given in the axilla; hypodermics 
of strychnine and hot brandy at four-hour in- 
tervals. After recovery from the shock the 
patient was put in a sitting position. 

After Treatment. — No food was given, and 
<»nly cracked ice by mouth for first 24 hours. 
Nutriment enemata of peptonized milk and 
warm coffee (with whiskey, zss) q. s. ziv., t. i. 
d. Then albumen water zii q. 2 hrs., and on 



third or fourth day milk z iv. q. four hours. On 
seventh dav soft-boiled eggs, milk and toast, 
soups; on twelfth day regular house diet. 

Drugs. — Strychnine, gr. 1-30 q. 6 hours, al- 
ternating with nitroglycerine, gr. 1-100, qui- 
nine sol. gr. ii ss, q. 3 hours. Nitroglycerine 
was dropped on sixth day. Patient's pulse, 
respiration and temperature rapidly improved 
until normal was reached. Each nutriment 
enema was preceded by a normal salt enema. 

Hypodermodysis of 800 c. c. normal salt so- 
lution was given daily for three days, which 
seemed to do great good. 

Dressing. — Wound was dressed daily for 
eight days, then every other day until he was 
discharged. On third day deep pelvic drain 
was removed ; on fifth day drain under liver 
was removed (discharge having ceased from 
these drains) ; on sixth day drain over stump 
of appendix was removed and shortened, again 
on eighth day, and entirely removed on twelfth 
day, and iodoform gauze used in its stead. At 
each dressing area around wound was thor- 
oughly cleansed with a 1-3000 bichloride sol. 
and the wound with a saturated solution of bo- 
racic acid. 

The patient was kept in a sitting posture 
until the eighth day, then gradually lowered 
until twelfth day. When discharged the 
wound was healed and no parasites could be 
found in his blood. 

This case was diagnosed and after treatment 
given by me while in charge of colored wards 
as substitute interne, Wilmington, N. C, City 
Hospital, from June to September, inclusive, 
1908. 



CORRESPONDENCE. 



SOME EXPERIENCES IN THE VALLEY 
OF THE AMAZON. 

(Concluded from February Number) 

This is the first night on shore for over a 
month ; although we were at Para for two days, 
sundown was the signal for a quick get-away to 
the Ravelston, and the anti-mosquito cottage on 
board. Dr. Lovelace was one of the pale-faced 
persons who came down to see our boat tie up to 
the bank. He appears to be a good one, and will 
take charge of the hospital in a few days. Porto 
Velho is a very queer place. A space of about 
ten square acres has been cleared and a general 






THE HOSPITAL BULLETIN 



store, the commissary and buildings for the engi- 
neers have been erected. A wall of dense vege- 
tation surrounds this clearing. You will see by 
the photograph that they are not little fellows. 
They are giants. The smallest is at least 8 feet 
in diameter ioo feet above the ground. Its 
lowest branches would just about escape the top 
of the Washington Monument, if placed along- 
side of Baltimore's patriotic effort. 

Supper was not bad, and these aenemic engi- 
neers are at least optimistic. 



is to meet me just above the Falls and paddle 
me up stream for two days to San Carlos. 

* * * * * 

This wonderful trip will never be forgotten. 
The canoe kept close to the shore at times, and 
it was almost like rowing through a great con- 
servatory. The river is high and the trees and 
vines trail in the water. Alligators are almost 
everywhere, and parrots and monkeys constantly 
remind you of their presence with their shrill 
cries. * >ften the rowers had to get out of the boat 




BOATS LOADING TO GO UP THE MADIERA RIVER ABOVE! SAN ANTONIO 



Next to the pickle jar was a large bottle of 
quinine. Nearly every man took 10 grains. Some 
took more, and all wanted to know the latest 
news from the States. Two of the men had only 
left the table for a few moments when they sep- 
arated themselves from their supper. Poor fel- 
lows ! It's "Algride" with them, I think. 



I left Porto Velho today in a launch for San 
Antonia, where tonight will be spent. An Ameri- 
can Indian, who was in the army in the Philip- 
pines, is with me to act as interpreter and ser- 
vant. At daybreak a canoe with native rowers 



and draw it with a long rope past some particu- 
larly rapid place in the river. When the canoe 
reached Tietonia the canoe was tied up below the 
balls and the cargo was unloaded and carried 
above the Falls to a small warehouse, preparatory 
in being placed on another canoe which is waiting 
to go up the river at daybreak. * * I was most 
fortunate last night, and instead of sleeping in a 
hammock, spent a pleasant evening and had a 
good dinner at the house of a Spaniard who is 
agent for a wealthy firm of rubber exporters. 

The Falls are not particularly high, but the 
volume is probably three times as great as that 
of Niagara, and the roar is deeper and stronger. 



THE HOSPITAL BULLETIN 



I stood there in the gray dawn and watched these 
native rubber bearers who were carrying the rub- 
ber around the Falls to be put in the canoe below, 
shuffle along. Each had a great ball of rubber 
on his head. Outside of the roar of the falling 
waters there was not a sound, and Dore must 
have seen some such weird place. His pictures 
would lead you to believe that he had. After what 
I have seen today I really don't care very much if 
I do get sick up country. San Carlos was reached 
in good time. San Carlos is on the map and printed 
in letters large enough to give the impression of 
a village, at least. San Carlos consists of a 
thatched three-room hut and a long shed for the 
16 pack mules. I have seen this deceptive way of 
marking even cross-road stations in Iceland and 
Norway also. I found here a Mr. T.. who is bad 
with the fever. He was carried down yesterday 
in a hammock by eight natives. Quinine will fix 
him right, I think. The storehouse keeper is out 
of his head and raving away at a great rate. It 
may be just fever, but I think he has poisoned 
himself with too much quinine. 

Tomorrow the start will be made for the in- 
terior, since the mule train has arrived. The 
mule team master is lame with a big ulcer on 
his leg. A tropical ulcer, no doubt, and he refuses 
to let me clean and dress it. 

Bags, scope and outfit were packed on mules 
and a seven-hour ride over a rough trail brought 
me to the front. You can't describe such a ride 
as this. So dense is the vegetation that the sun's 
rays reach the earth only as long pencils of light. 
Wonderfully brilliant butterflies flutter about in 
the cleared trail, and when they chance to cross a 
slanting sunbeam for an instant they flash into 
view like an explosion of burning color. 

It is hard to imagine the effect they produce as 
their wings flash and close and flash again in 
the sunlight. In places the trail is carpeted with 
fallen blossoms inches deep. Pale pink, deep 
blue, lavender, orange, almost every color of the 
rainbow. We marvel at the beauties of some of 
our great conservatories, but in comparison with 
this wonderland they sink to the level almost of 
the toy gardens some diligent fathers build under 
the Xmas trees for their own as well as their 
childen's delight. Monkeys, small and large, 
scamper along and peer down at you. Twice dur- 
ing the day I saw enormous spiders. One killed 
by an engineer measured eleven and three-quar- 
ler inches from one front to the opposite hind leg. 



Hard to believe, I know, but a twenty-five foot 
four inch snake was killed by our preliminary 
party. Bichloride was all I had to prevent its 
skin from rotting, and a severe illness from 
bringing it back to the States with me. 

The camp was reached before dark and a cor- 
dial welcome awaited my guide and myself. Of 
the 14 white men in camp three were quite sick 
and several others about as an anaemic a looking 
lot as I ever saw. Of the 40 odd laborers I 
learned later jj per cent, had been sick during 
June. * ::: * 

We are now in a part of the world unknown 
before to white men. Parrot soup and fried 
monkey were served at my first meal. Monkey 
meat is very tough. Put the photograph of the 
camp will show you how wild this country is. 
Wild pigs are good to eat, but hard to shoot, and 
so parboiled parrots and rice soup made from 
them is at times acceptable, and, except for the 
toughness of it. monkey meat is not at all bad. 



The 2,000-mile journey up stream is over and 
our ship is already tied to the banks at Porto " 
Velo, near San Antonio. We should have landed 
an hour ago, but there was some trouble with the 
custom officers. Every boat that comes up the 
Amazon must bring along two pilots and two 
custom officers from Para. The pilots draw enor- 
mous salaries and are very big people. And they 
are grafters of the first water. It is reported 
that when we left Serpa it was necessary for Mr. 
M. to hand out 6 Cantos before the freight 
steamer could have a clean bill. A Canto is one 
thousand milres, or about $320. And all this 
after the duties had been properly attended to at 
Para before leaving there. 

Either most of the people are far from well or 
there is a tropical look which one may get used to 
later. We are not yet landed, but all of the 
people from the camp near the top of the bank 
have come down close to the boat. They look far 
from strong and walk as though they were just 
out of bed. convalescing from a typhoid fever 
attack. 

Here at Porto Velo I am making hasty but 
complete preparation to go up the river, where I 
will join the preliminary exploration party which 
has penerated into a part of the jungle never 
before seen by white men. 



It seems almost impossible for me to get along 



THE HOSPITAL BULLETIN 



to Beri-Beri, tropical ulcers, dysentery, and. most 
of all, malaria. 

It must be borne in mind that the people of this 
region come from many parts of the world. They 
are contract laborers, brought from the Isthmus, 
Spain, Portugal and from the coast. They are 
brought to work on the new railway. They get 
sick, and mostly they are sent home as per con- 
tract. They don't last long - . Latent diseases de- 
velop shortly after arrival at headquarters. Sub- 
tertian malaria, shown by blood examination of 
many new arrivals, required less than a month to 
spring into life after locating in the fever zone. 
Every one of them, and the engineers also, get 
the fever without exception. Everything is 
grafted on malaria. The anapholes leads the 
German. Anklastoma and Ascaris Lumbracoides 
bring up the rear. Tropical ulcers are present in 
many cases and are often bilateral. 

One of the most interesting diseases observed 
was tick fever. I was fortunate in having two 
cases to study in a period of nearly two months, 
and I will give the history of one case later. Why 
more cases did not develop is odd, for each night 
it was necessary to search carefully and remove 
the day's crop. It was a continual case of sweat 
bees, stinging flies and piums. There are surely 
chances for infection not yet known. Later many 
of the undifferentiated fevers will be better un- 
derstood and their etiology is only a matter of 
time. Very truly. 

Albert 1 1. Carroll, M, 1). 



.Mcdowell hall, historic main 

p.uilding at st. john's college, 

department of arts and 

sciences, destroyed 

BY FIRE. 

McDowell Hall, named after John McDow- 
ell, LL. D., first president of St. John's, the 
main building at St. John's College, Annapolis, 
was destroyed by fire February 20, 1909. 

The fire started in the upper part of the 
structure and rapidly spread to the cupola. 
Practically all of the furnishings of any value 
were saved, including the equipment of the 
fraternity rooms, college records and the large 
and valued collection of class shields that 
adorned the balconies of the chapel ball. 

The destruction of the building is practically 
complete, a section of the east wall some seven 



feet deep having" tumbled down, and it is 
thought probable that other parts of the wall 
have been weakened to such an extent that 
they will fall. The falling of the wall caused 
much regret among the college authorities, as 
the plan of rehabilitating the structure with 
the use of the original walls had been dis- 
cussed, and much of the historical interest of 
the building, therefore, would have been re- 
stored. 

The loss to the structure and contents of 
over 840,000 is covered partially by insurance 
of $25,000. 

McDowell Hall, the oldest building of the 
college group, is one of the most interesting of 
the historic buildings of Annapolis. It was be- 
gun in 1744 by Governor Thomas Bladen, but 
the legislature of the colonies decided that he 
had exceeded his power in appropriating the 
money for the erection of the building and or- 
dered the work stopped. 

It remained partly completed until 1784, 
when the building and ground upon which it 
stood was transferred to King William School, 
which then became St. John's College, and the 
money for its completion was appropriated by 
the state. 

Since that time it has been used as the main 
building of the college group. In 1886 the cu- 
pola was set on fire by- a bolt of lightning, but 
the fire was extinguished without serious dam- 
age being done. 

In front of the building stands the "liberty 
tree," a tulip, under which it is said a treaty 
with the Indians was made. 

The friends of liberty also held meetings under 
the tree in the days just before the Revolution. 
The tree is supposed to be older than Annapolis. 

Unanimously moved by the determination 
that a more ample McDowell Hall should rise 
from the ruins of the old one, and that the new 
structure should be built upon the lines of the 
old, and be included as far as possible within 
its historic walls, the movement for the recon- 
struction was launched at an enthusiastic meet- 
ing of the alumni and influential friends, which 
was held in the college library February 25, 
1909. The meeting went into the consideration 
of the resolutions which were to be presented 
to the board of visitors. The resolutions sug- 
gested that architects be employed to test the 
possibility- of retaining the old walls and to de- 



8 



THE HOSPITAL BULLETIN 



vise plans for the rebuilding, with such wings 
and additions as would not destroy the old plan 
or disassociate it with its historic traditions. 
The cost of the new building was placed at ap- 
proximately $100,000. The resolutions further 
urged that a committee be appointed at once to 
lay the claim of the institution before the pub- 
lic, and particularly before men and women 
of wealth and philanthropic disposition and be- 
fore the custodians of public educational funds. 

After the passage of this resolution another 
resolution, offered by Judge Henry D. Harlan, 
of Baltimore, a graduate of the college, provid- 
ing for the appointment of an alumni committee 
on the rebuilding of McDowell Hall, was carried. 
The committee will be appointed later. 

At the conclusion of the formal business Mr. 
Poe presented the resolutions of regret and sym- 
pathy of the Regents of the University of Mary- 
land, of which St. John's is the academic depart- 
ment. 



DO IT NOW, 



According to an editorial in the February issue 
of The Hospital Bulletin, the long-cherished 
dreams of a president of the University of Mary- 
land appears to be a possibility of the not distant 
future. Announcement of the creation of this 
< rffice and its first incumbent may be announced 
at any moment by the Board of Regents, who 
have at last come to recognize the disadvantage 
under which our institution labors before the 
public, alumni, benefactors and sister institutions. 
That the Board of Regents has appointed a com- 
mittee from its number to investigate and report 
the ways and means of providing a president, is 
indeed welcome news to all loyal alumni. For 
some time alumni have been agitating the crea- 
tion of this office, and the appointment of this 
committee was the result. The Regents are to 
be congratulated upon this move, which should 
forever hush the accusations that the institution 
is being run solely in the interest of the members 
of the several faculties. 

Now it is up to the alumni to aid and abet the 
Regents in every way possible to consummate 
such a desirable, yea necessary, change. Let's 
cease petty carpings and whoop it up. Let's pre- 
sent a solid front and show devotion and loyalty 
by providing at least a partial endowment 



towards a presidency. In no other way could 
the alumni more materially manifest an earnest 
in this movement. Every alumnus should be not 
only willing, but glad to aid in the procurement 
of a president. If the alumni have ever felt a 
tinge of love for the University, any pride in its 
past glories, any hope of future greatness, this is 
the time of times to express it in a material way. 
If one ever contemplate doing anything for 
Alma Mater, do it now, for ye knoweth not what 
tomorrow bringeth forth. 

Another matter which shows the Regents alive 
to the need of the times is the cordial reception 
given a petition from the General Alumni Asso- 
ciation imploring the creation of a Board of 
Alumni Counsellors. This has likewise been re- 
ferred to a special committee for mature and 
deliberate consideration. To be candid, the Re- 
gents recognize the defective organization under 
which they are laboring, and if proper support 
and encouragement is extended to them, this no 
doubt will be changed. Indeed, there is talk of 
petitioning the next Legislature for a new char- 
ter. The burden of managing such extensive 
property interests has become too onerous to the 
professors, who are more than willing to transfer 
this trust to other shoulders, provided the change 
will not bring chaos. It is no more than just that 
our alumni meet this spirit of sacrifice with as 
much sacrifice upon their part. Here is your 
long-sought-for opportunity to aid in the uplift 
of our dearly beloved University. See that you 
make the best use of your opportunities. Deny 
yourself something to render her a service, not 
necessarily pecuniary; attendance of the meet- 
ings of the General Alumni Association, a body- 
organized for the creation of the "University 
Idea," a fosterer of all which is good for the 
University, a body which has from its inception 
worked constantly against almost insurmountable 
barriers for the placing of the University upon a 
sound basis, a body which has the temerity to 
petition the Regents for a general Centennial 
Celebration and a paid head for the institution, 
but also for a Board of Alumni Counsellors, is a 
most valuable service. Show your interest in our 
institution by your presence ; you have been 
clamoring for recognition ; show your loyalty and 
sincerity by attending the meetings of the Gen- 
eral Alumni Association, where these momentous 
questions are under consideration and delibera- 
tion. Al.UMNUS. 



THE HOSPITAL BULLETIN 



9 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

EDITED BY 

A COMMITTEE OF THE HOSPITAL STAFF 



PUBLISHED BY THE 

HOSPITAL BULLETIN COMPANY 
University of Marvland 



Business Address, Baltimore, Md. 

Editorial Address, .... University of Maryland 



Baltimore, Md., March 15, 1909 

EDITORIAL. 

Beginning of Volume V. — With the present 
issue The Bulletin begins its fifth year of pub- 
lication. In looking back over the four years 
past the L<litor and Business Manager of The 
Bulletin have cause, both for satisfaction and 
for regret. It is some satisfaction to have kept 
the regular monthly issues before its many read- 
ers when the difficulties of the task and the many 
embarrassments which are associated with the 
publication are taken into consideration. It is a 
source of regret to know that The Bulletin 
has not reached the high standard which is to be 
desired.' 

When it is borne in, mind that The BULLETIN 
is a class organ dependent upon a single class of 
readers and subscribers, it can be readily under- 
stood bow difficult it has been to obtain matter 
for its reading columns and money to meet its 
business obligations. That The Bulletin could 
be made a much better publication than it is the 
editor is painfully aware. If he has not done 
the best he could, he has done the best that it 
was possible for him to do under existing cir- 
cumstances. The editor has many and pressing 
duties calling for his time and energies apart 
from the work he has given to The Bulletin. 
He has only worked for The Bulletin from 
force of necessity, because up to the present time 
he has not been able to impose this work on an- 
other's shoulders. His desire to see the publica- 
tion live and do a service to Alma Mater and to 
her Alumni has been the only motive which could 
have held him to the job for four years. 

The time is near at hand when some younger 
and more 'capable 'man connected with the Med- 
ical Department of the University should take 
up the entire management of The Bulletin and 
relieve its present tired-out representative. It is 



earnestly hoped this individual will be found at 
no remote date. The Bulletin needs not only 
a more energetic and progressive editorial man- 
agement, but it most urgently needs a more 
capable business head. In this age brains and 
money are essential to progress. The man who 
has the brains to do good work and the money 
to aid in the development of an enterprise is the 
man who will get results. The Bulletin looks 
for no marked progress in its work until this 
man is found. 

Recognizing the shortcomings of the present 
management of The Bulletin, it is but fair to 
state that the alumni and friends of the Univer- 
sity owe something to the publication which has 
tried to serve them for four years. If a more 
liberal financial and literary support was given 
The Bulletin would soon be able to reflect this 
support in its reading matter. When an editor 
is forced to beg for material and to dun his read- 
ers for money his amiability is sorely taxed and 
his work is unsatisfactory. 

The Fire at St. John's College. — The 
Alumni of the University of Maryland will 
learn with deep regret of the recent destruction 
by fire of the venerable McDowell Hall, at St. 
John's College. This old building possessed 
not only a practical value, but an historic in-, 
lerest. Its loss is one which cannot be restored 
in full. 

Since St. John's College has become by af- 
filiation the Department of Arts and Sciences 
of the University a strong bond of union has 
grown up between the different departments, 
and the ties of interest and friendship have 
been greatly strengthened. Any misfortune, 
coming to any one department will be keenly 
felt by all departments of the University. 
I lence the sympathies of all of the Alumni, will 
go out to St. John's in her recent loss. It is an 
ill wind which blows no good. The Bulletin 
believes that the loss sustained by St. John's 
will in the end work greatly to her advantage — 
that she will arise from her ashes with renewed 
vigor and purpose, and with a modern equip- 
ment for her educational work. The growth of 
St. John's during recent years has been marked 
for thorough and progressive methods. Not 
only has she grown in number of students and 
in the high character of her teaching body, but 
she has improved her courses of instruction to 



10 



THE HOSPITAL BULLETIN 



meet the standards of the leading colleges of 
this country. 

The military and educational training she 
gives her students will, we believe, measure up 
to that given by any college of like character 
in America. The location of St. John's at An- 
napolis, the capital of the state, is exception- 
ally fortunate. The social life and healthy en- 
vironment of Annapolis give a valuable stim- 
ulus to student life in that community. With 
the Naval Academy and St. John's College An- 
napolis has become an educational center of 
wide distinction. The association of large stu- 
dent bodies and large corps of teachers with 
the refined society of the capital of the state is 
highly beneficial to all classes. 

The Bulletin - indulges the hope that the 
burning of McDowell Hall will call attention 
to the claims of St. John's College upon the 
people of Maryland, and that our legislature 
will deal generously with this venerable school, 
which has so long served the youth of our state. 



ST. JOHN'S LOSS. 

There is more than the usual loss in the burn- 
ing of any of the old buildings at Annapolis. 
One around which history clustered with special 
interest was McDowell Hall, and its destruction 
on Saturday was a great misfortune. 

Friends may and should rush to give to St. 
John's a main building that will take its place and 
have many comforts and facilities which Mc- 
Dowell did not possess, but nothing can possess 
that peculiar value which comes from the long 
association of many distinguished names. 

In this connection it is worth while to remem- 
ber that St. John's College has done great work 
for Maryland, and that it ought to have a larger 
support from the people of the state. The re- 
building of McDowell Hall might very appro- 
priately he the beginning of a new era in the life 
of the college. It presents a fine opportunity for 
its well-to-do and public spirited alumni. — Edi- 
torial, Star. 



HOSPITAL SHIP FOR THE POOR— HAR- 
BOR ENGINEER LACKEY INDORSES 
MR. HELLER'S PLAN. 

City Councilman Heller has introduced in the 
City Council a resolution providing fur the ap- 
pointment of a commission to report <>n plans for 



the establishment by the city of a hospital ship 
in summer for the poor. Harbor Engineer 
Lackey is in accord with the suggestion, and has 
promised to co-operate in the project. 

The vessel would be used by poor sick people 
and would make daily trips on the hay. Efforts 
would be made to have it accommodate 1,000. Mr. 
Lackey said such a boat could be built for $30,000 
and has suggested that churches, lodges and busi- 
ness and improvement associations may be gotten 
interested in it, and the ship be built by pop- 
ular subscription and maintained by the city. 



A MOCK TRIAL. 



Under the Direction of Joseph T. Smith, M. D., 

Department of Medicine; Mr. Eli Frank, 

Department of Law. 

Reported by J. T. S. 

On the evenings of February 12th and 13th 
a mock trial was held in Davidge Hall in which 
students from the Medical and Law Departments 
took part. The synopsis of the case was as 
follows : 

( )n the morning of December 10th William 
(iillis died, and James Atchison, his nephew, 
is charged with causing his death by the ad- 
ministration of tartar emetic. The circum- 
stances are as follows: 

William had been sick for a week, complain- 
ing of headache, nausea and weakness. He was 
a man of sixty years of age and always en- 
joyed good health. At times, however, he 
would indulge in drink, but had not for some 
weeks before his last sickness. His physician 
in attendance could find no special cause for 
the trouble, and as, under treatment to allay 
the symptoms, his patient improved, he was 
satisfied. 

( )n the morning of December 9th William 
did not seem so well — had more headache and 
vomited for the first time. The physician saw 
him twice that day, and. although his patient 
had vomited several times, he was not able to 
see the vomited matters, as they were thrown 
out before his arrival. At midnight the doctor 
was hastily summoned, as the messenger said 
'tis patient was much worse. Upon arrival he 
found his patient delirious, and soon after con- 
vulsions set in. These were relieved by the 
administration of chloroform, but recurred 
when the influence of the drug wore oft*. After 



THE HOSPITAL BULLETIN 



11 



working with him until 7 A. M., the man broke 
out into a cold perspiration, collapse set in. and 
the man died at 8 A. M. 

The vomited matters, having been thrown 
out. could not be bad for examination. The 
physician, from the condition of his patient, 
suspected poison, and in looking about found 
a tumbler in a cupboard in the bottom of which 
was a small quantity of a white sediment. 
This, upon analysis, proved to be tartar emetic. 
His nephew, who was his constant attendant 
and the heir to his fortune, was accused of ad- 
ministering small amounts of tartar emetic, 
and, not getting the results he desired, finally 
gave him a larger dose. The sediment in the 
glass he alleged was left over from some he 
had used in making a poison paste for rats. 
While no tartar emetic was found in the stom- 
ach, it was contended that its absence proved 
nothing, as it might have all been thrown up 
at the time of the vomitings. The mucus mem- 
branes showed congestions, as did the stomach, 
but as it was known that the man had taken 
powders to control his drink habit, and as it 
was known that these contained antimony, the 
defense alleged that the man had been' taking 
some of the powders before he was taken sick. 
It was proved that he had taken none of them 
during his sickness, and that the congestions 
were due to the tartar emetic in said powders. 

The court proceedings were carried on with 
all the detail and dignity of a real court of jus- 
tice, those present rising and standing until the 
judge took his seat, the crier calling the court 
to order, the calling of the roll of the jurors, 
clerk, reporter, counsel and witnesses, both or- 
dinary and expert. The court was constituted 
as follows: 



Witnesses for Defense: 



Judge — Eli Frank. 
Clerk — G. C. Feurst. 
Crier — 

Geo. McG. Benson. 
Bailiff— Benj. Reck. 
State's Attorney— 

R. Legare Welti). 



A.-sist. State's Attorney. 

Samuel J. Fisher. 
Counsel for Defense — 

Frank B. Evans and 

A. H. Siskend. 
Sheriff— W. Lnn. 
Prisoner — Mr. Ebert. 



Witnesses for the Prosecution: 



Family Physician — 
Charles Schmidt. 

Chemist — 
H. W. Coddington. 

Butler- 
Raymond C. Reik. 



Post-Mortem. Physician, 

Jose Igartua. 
Druggist Relief Clerk— 

Jas. G. Edelen. 



Chemist — 

R. C. Howard. 
Medical Expert — 

J. Ostro. 
Prisoner — Mr. Ebert. 



Medical Expert — 

I. M. Macks. 
Chemist— Mr. Alfeld 
Druggist — 

E. E. Nichols. 



Jurymen: 



R. E. Jones, Foreman: 

E. H. W'ooten, 

E. E. Hearn. 

Arthur Trader. 

W. H. Chambers, 

S. E. Mueller. 



David Ford. 
Mr. Wolf, 
J. J. Greengrass, 
Mr. Mullen, 
.Mr. Hubbard. 
Mr. Backrack. 



The attendance of the students was excel- 
lent, and all seemed greatly interested in the 
proceedings, which were instructive, with just 
enough variety, and at times amusement, to 
prevent monotony. The judge presided with 
dignity, and was called upon on several occa- 
sions for his decision, owing to the disagree- 
ments of counsel. The disagreements of coun- 
sel, the objections of one side to the questions 
of the other, and the discussions arising there- 
from, gave all present a good insight into the 
way lawyers watch the interests of their 
clients. The excellent examinations, cross-ex- 
aminations and re-examinations presented the 
manner of securing evidence in a most favor- 
able light. Much amusement was occasioned 
when, upon cross-examination, a witness was 
asked to state the difference between antimony 
and alimony. Upon the question being ob- 
jected to, counsel said he was trying to test the 
general knowdedge of the witness. The judge 
allowed the witness to answer. An old man 
1 the chum) came in with a cane and books 
under his arm, and well represented the garru- 
lous witness. The medical experts, the chem- 
ical experts, the butler and the family physi- 
cian did themselves great credit as witnesses, 
and presented such a variety as to make that 
portion of the trial intensely interesting and in- 
structive. The introduction of a glass having 
a sediment and of the record of the druggist 
with an erasure added to the interest. The age 
of some of the witnesses, the possession of an 
automobile by one, the length of time another 
had been in practice and the prize obtained by 
a third for a paper on tartar emetic afforded 
much amusement. The speeches of counsel at 
the close were listened to with interest, the ar- 
raigning of the opposition witnesses by one. 



12 



THE HOSPITAL BULLETIN 



the fervid eloquence of another and the careful 
presentation of the testimony of the witnesses 
bv a third made a pleasing and interesting va- 
riety, and exhibited in a most engaging manner 
the diverse ways in which the jury receive the 
important points in regard to a case and have 
presented to them the matters testified of by 
the witnesses. 

All present were gratified by the ability dis- 
played by the students, for it was left entirely 
to them to work out antl present the case. 

This is the first attempt of the kind that 
has been made, and it was successful in giving 
the students a clear insight into court proceed- 
ings and cil bringing about a more intimate re- 
lationship between the Medical and Law De- 
partments, a relationship which, if it were as- 
siduously cultivated, would do much towards 
promoting a more sympathetic feeling between 
these great professions when the students go 
"lit as active physicians and lawyers. 



[TEMS. 



THE CANDIDATE'S PRAYER. 



Dr. R. C. Buqk, of the class of 1S74, now 
practicing his profession with success and dis- 
tinction at Garrison ville, Va., writes to the ed- 
itor of The Bulletin that the following verses 
were removed by him from the Bulletin Board 
in the hall of the University, and have been 
kept by him as a souvenir for the past 35 years. 
The author, he thinks, was Dr. Norris, of his 
class, long since dead : 

My carpus anil each phalanx is 

Jagg'd. numb and worn and cramped; 

My poor encephalbn o'ertaxed, 
My energies all damped. 

My conjunctivae arc suffused. 

With films my iris hooded; 
My Dura Mater's sinuses 

Willi tun much blood arc flooded. 

And O, my nervous system is 

All shattered and o'erstrung; 
The ei mstant studying because 

The "physic-books" among. 

My stomach does but ill secrete 

Its proper juice, the gastric. 
Depending on derangement of 

The Eighth — the pneumogastric. 



And my own cutis. I know 't well. 

Is of a sickly sallow 
(Although I've taken Calomel). 

It's stained a bilious yellow. 

My ills. God save the mark! are great. 

And my afflictions legion; 
At times I feel a deadly weight 

In my precordial region. 

And Phthisis Pulmonalis, too, 

Makes to me its migration; 
For I've been told that I. alas! 

Had bronchial respiration. 

But it's no marvel that I'm sick; 

Six lectures, sometimes seven. 
Each day, and then the "Quiz" to boot 

Five times per week, good Heaven! 

And then withal the deadly fear 

Of being "pitched" when I 
Within the "Green-Room" shall be asked 

The wherefore? and the why? 

Therefore incline Thy bounteous Ear, 

Thou Lord divinely great. 
And O, fulfil the earnest pray'r , , , 

Of me. A Candidate: 

"Make our Professors' breasts to feel 
Some kindliness when they 
Examine us poor- fellows on 
A not far-distant day. 

"Make that they may recall the time ; 

When they were students yet; ' '• 

Their own sad fears and doubts, good' Lord! 
Let them not then forget! 

'Make them recall that we were forced 

To "cram" — and hence forgot . ■ 

The details, the minutiae. 

Though maybe gross things not. 

'Let them remember that it took 

Them years of study to 
Learn all they know — and let them look 

On us with friendly view!" 



THE VILLAGE DOCTOR. 

A Parody on the Village Blacksmith. 

By the Editor. 

Seated in his one-horse chaise, 

The village Doctor makes his rounds; 

The Doctor, a grand old man is he. 

Whose weight is scant two hundred pounds 

But when the call for help is made. 
The Doctor at his post is found. 



THE HOSPITAL BULLETIN 



13 



lli* hair is white, thin and long, 

His face is full of cheer; 
His brow is knit with anxious thought, 

He knows no sense of fear; 
lie stares disease full in the face. 

For life to him is dear. 

Day in, day out. from year to year, 

You sec him come and go; 
You see him on some mission bent. 

You hear his old horse blow; 
He stops not for Summer's sun. 

Nor Winter's blasts of snow. 

The children coming home from school 

Greet him passing by; 
They love to cheer the grand old man. 

Perched in his old chaise high; 
As they catch his kindly greetings 

They seem to hear him sigh. 

On Sundays when he goes to church. 

He sits quite near the door; 
He hears the parson pray and preach, 

He thinks about the poor, 
N'eeding. perhaps, his services, 

And it makes him sorrow more. 

He recalls the sick and suffering. 

How on beds of pain they lie; 
He needs must give relief to some. 

But some are sure to die; 
His big heart fills with emotion 

As tears drop from his eye. 

Sorrowing, toiling, comforting, 

Onward through life he goes; 
Each morning finds him at his task, 

Which evening does not close; 
Someone helped, others calling. 

But night brings no repose. 

Thanks, thanks to thee, our dear old friend. 

For the good which thou hast done! 
For all thy deeds of kindness. 

For all the victories won; 
May angel voices praise thee 

Where angel songs are sung. 



The Nineteenth and Sixth Annual Meeting 
<>f the General Alumni Association was held in 
the Law Building of the University of Mary- 
land, Tuesday, February 23, IQOQ, at 8.30 o'clock 
P. M. 

Very important business was discussed and 
several resolutions of great moment to the Uni- 
versity were introduced. The first order of busi- 
ness was the adoption of resolutions of sympathy 
for our sister department, St. John's College. 
Department of Arts and Sciences, on the loss of 
McDowell Hall. The resolutions were as fol- 
lows : 



Whereas we recognize in the loss of this old 
colonial building, the chief glory and honor of 
St. John's and one hallowed by over a century 
and a half of association, an irreparable catas- 
trophe to this University, to the State of Mary- 
land, and to the cause of education : 

Resolved ( 1 ) , That we extend to President 
Fell and the authorities of St. John's our warm- 
est sympathies in their misfortune and our earn- 
est hope that it may lead many generous friends 
to contribute so liberally that a greater and more 
glorious McDowell Hall, may arise Phoenix like 
from the ashes. 

(2) That we pledge ourselves to do everything 
in our power to secure this result, and hereby di- 
rect our Committee on Endowment to open a sub- 
scription list among our alumni and the citizens 
of Baltimore. 

(3) That a copy of these resolutions be sent t<> 
1 >r. Fell and also given to the press. 

Dr. John C. Hemmeter delivered an addre^- 
advocating the creation of a Board of Alumni 
Counsellors. Although Dr. Hemmeter did not 
speak officially for the Board of Regents, still he 
suggested that such a proposition would receive 
favorable consideration by that Board. This 
would mark a distinct step forward by the Uni- 
versity-, and no doubt would be greatly appreci- 
ated by the alumni. There has and is still a feel- 
ing that the members of the Faculties of the Uni- 
versity do not desire any outside interference. 
and that the University is a closed corporation 
run for the benefit of the professors. Such a 
gracious act as the countenancing of a Hoard of 
Alumni Counsellors would at once dispel this 
distrust. A motion was made by Dr. Wilkinson, 
and amended by Dr. Taneyhill, that the chair ap- 
point a Committee of Ten to consider the matter 
and report at the next meeting. This motion was 
seconded by Dr. Hynson. 

The next order of business was a resolution 
equally as pregnant for the welfare of the Uni- 
versity as that just mentioned. This was pro- 
posed by Dr. Hopkinson, and seconded by Dr. N. 
Winslow, and was as follows : 

Whereas the progress of the University of 
Maryland appears to be greatly impeded and its 
participation in the great educational founda- 
tions prevented by the present organization of 
the governing body ; be it 

Resolved, That the General Alumni Associa- 
tion of the University of Maryland implores the 



14 



THE HOSPITAL BULLETIN 



Regents to take such steps as will remedy the 
existing' conditions by the election of a paid Pro- 
vost or President, with a governing' body inde- 
pendent of the teaching bodies. 

A motion was made and passed that a com- 
mittee of three be appointed by the chair to re- 
vise the rules and regulations. 

The following officers were elected for the en- 
suing year: President, J. B. Thomas, Ph. G. ; 
First Vice-President, Isaac Davis, M. D., D. D. 
S. ; Second Vice-President. James E. Carr, Jr.. 
LL. B. ; Third Vice-President, J. Fred Adams, 
M. D., St. John's; Fourth Vice-President, Ran- 
dolph Winslow, M. D. ; Fifth Vice-President, J. 
W. YVestcott, Phar. D. ; Treasurer, Daniel Base, 
1'h. D. ; Secretary, Chas. G. Sadtler. M. D. 

Executive Committee — Dr. B. Merrill Hopkin- 
son; L. W. Farinholt, D. D. S. ; II. P. Hynson, 
Phar. D. : J. II. Skeen. LL. 1'..: Jacob Bird, M. 
D.. St. John's. 

Endowment Committee — E. F. Cordell, M. D. ; 
Judge Henry Stock-bridge : C. V. Matthews, D. 
D. S. ; Leroy Robinson. Ph. G. ; L. B. K. Clag- 
gctt. St. John's. 

According to a ruling of the chair, the presi- 
dency rotates among the various departments, 
and as Law, Medicine and Pharmacy have had a 
representative in the chair, the next incumbent 
will be a representative of Dentistry, and two 
years hence a graduate of the Department of 
Arts and Sciences. 



Dr. Hiram Woods was recently registered at 
the Chalfonte, Atlantic City. 



1 )r. St. Clair Spruill has returned from Atlantic 
City, where he was recuperating from an attack 

i if appendicitis. 



Dr. Norman Dudley, class of 1901, of Church 
Hill, Md., recently visited the Hospital. Among 
other recent visitors were Dr. Rollin Jefferson. 
Jr., of Tampa. Fla.. and Dr. Byron \Y. Eakin, 
class of 1903, of West Virginia. 



Dr. Claude Van Bibber-, class of 1X77. of Bal- 
timore, one of the best known physicians in the 
city, has been seriously ill at his home, 9 E. Read 
street, as the result of a fall several weeks ago. 
1 )urinsr the last snow 1 )r. Van Bibber was called 



out late at night and slipped on the ice. He paid 
little or no attention to the accident until several 
days later, when he complained of severe pains, 
and was forced to go to bed. Though 52 years 
of age. Dr. Van Bibber is a man of strong and 
healthy physique. 

Dr. Van Bibber married Miss Margaret Co- 
hen, daughter of Judge M. M. Cohen, late of the 
Supreme Bench of Louisiana. They have three 
children. 



Mr. T. A. Joyues, of 2330 Eutaw place, an- 
nounces the engagement of his daughter, Miss 
Julia Armistead Joynes, to Dr. Arthur Marriott 
Shipley, of Baltimore. The wedding will take 
place in June. 

Dr. Shipley is a native of Anne Arundel 
county, Md., and took his degree of medicine 
with the class of 1902, University of Maryland, 
of which institution he is now an. associate pro- 
fessor. After his graduation Dr. Shipley held 
the post of assistant surgeon at the University 
Hospital until June, 1904, when he was ap- 
pointed medical superintendent, which position 
he held until June, 1908. 



The Alpha Chapter of the Kappa Sigma Fra- 
ternity, University of Maryland, received at the 
Fraternity Flouse. 130 West Lanvale street, re- 
cently. The house was decorated with smilax 
and cut flowers. After the reception there was 
a dance. 



Dr. Walter Wickes. class of 1900, and Mrs. 
Wickes have taken an apartment at the Wash- 
ington and will make their permanent home in 
Baltimore. 



The following of our alumni are on the State 
Board of Health of Maryland: 

Secretary and Executive Officer — Dr. Mar- 
shall Langton Price, class of 1902, 10 South 
street. Baltimore. 

Laboratory Assistant — Dr. Harry W. Stoner, 
class of 1907, 1826 East Monument street. Bal- 
timore. 

Bacteriologist — Dr. Wm. R. Stokes. 1639 
North Calvert street. 



Dr. John A. Tompkins, class of 1898, is lieu- 
tenant and surgeon. Maryland Naval Brigade. 



THE HOSPITAL BULLETIN 



15 



The following' of our alumni arc county 
health officers : 

Anne Arundel — Dr. James J. Murphy, class of 
1S96, of Annapolis; First Precinct, Fifth Dis- 
trict, Dr. II. Brooke, Brooklyn, class of 1891. 

Baltimore County — First District, Dr. Arthur 
H. Mann, Jr.. class of 1890, Catonsville ; Third 
District. Dr. II. A. Xaylor, class of 1900, Pikes- 
ville; Fourth District, Dr. Harry M. Slade, class 
of 1884, Reisterstown : Fifth District, Dr. B. F. 
Price, class of 1857, of Mt. Carmel ; Sixth Dis- 
trict, Dr. John B. Norris, class of 1866, of Beck- 
leysville ; Seventh District, Dr. E. W. Heyde, 
class of 1892, of Parkton ; Ninth District, Dr. R. 
C. Massenberg, of Towson ; Eleventh District, 
Dr. James F. H. Gorsuch, class of 1876, of Fork ; 
Twelfth District, Dr. W. C. McClannahan, class 
of 1902, of Highlandtown. 

Caroline — Dr. Enoch George, class of 1872, of 
Denton. 

Carroll — -Second District, Dr. Luther Kemp, 
class of 1887, Uniontown ; Sixth District, Dr. 
John F. B. Weaver, class of 1864, Manchester; 
Seventh District, Dr. Charles R. Foutz, class of 
1897, Westminster; Eighth District, Dr. Richard 
F. Richards, class of 1897, of Hampstead; Ninth 
District, Dr. Edwin D. Cronk, class of 1884, of 
Winfield; Eleventh District, Dr. George II. 
Brown, class of 1864, of New Windsor ; Twelfth 
District, Dr. James Watt, class of 1863, of Union 
Bridge ; Thirteenth District, Dr. W. F. Gaver, 
class of 188—, of Mt. Airy. 

Dorchester — Dr. Guy Steele, class of 1897, of 
Cambridge. 

Garrett— Dr. II. W. McComas, class of 1888, 
of Oakland. 

Harford— Dr. W. B. Kirk, class of 1893, of 
Darlington. 

Queen Anne's — Dr. A. E. Landers, class of 
1907, of Crumpton. 

Talbot — Dr. E. R. Trippe, class of 1862, of 
Easton. 

Washington — Dr. J. E. Pitsnogle, class of 
1889, of Hagerstown. 

Wicomico — Dr. Charles R. Truitt, class of 
1891, of Salisbury. 



The following of our alumni are town health 
officers : 



Aberdeen — Dr. Charles R. Kriete, class of 
1895. 

Brunswick — Dr. Levin West, class (if 1886. 

Cambridge — Dr. J. C. Travers, class of 1895. 

Cumberland — Dr. George L. Carder, class of 
1891. 

Easton — Dr. Philip L. Travers. class of 1902. 

Frostburg — Dr. J. M. Price, class of 1890. 

Kensington — Dr. Wm. L. Lewis, class of 1892. 

Laurel— Dr. W. F. Taylor, class of 1884. 



Dr. Marshall L. Price, class of 1902, is a mem- 
ber of the State Board of Health of Maryland. 



Dr. tiny Steele, class of 180,7, of Cambridge, 
is one of the managers of the State Tuberculosis 
Sanitarium, located at Sabillasville. 



The following of our alumni are members of 
the Board of Medical Examiners of Maryland: 
Dr. Plerbert Harlan, class of 1879, of Baltimore ; 
Dr. W. \Y. Goldsborough. class of 1901, of 
( ireensboro. 



The following of our alumni attended the last 
meeting of the Hook and Journal Club, held at 
the Medical and Chirurgical Building: Dr. Hi- 
ram Woods. Dr. J. Whitridge Williams, Dr. PI. 
M. Thomas, Dr. William Royal Stokes. 



Dr. W. 1). Scott, class of 1905. is vice-presi- 
dent of the Baltimore Alumni Association of the 
Virginia Military Institute, lie is also on the 
banquet committee. 



Friday, February 26. 1909, Dr. T. Chew 
Worthington, class of 187(1, read a paper entitled 
"The intranasal frontal sinus operation. The ac- 
cessibility of the sinus and the prognosis of the 
operation." before the Section on Laryngology 
and Rhinologv. 



Dr. William II. Welch was the guest of honor 
recently at a banquet tendered him by the Beta 
Alpha and the Beta Beta Chapters of the Nu 
Sigma Nu Fraternity at the Belvedere Hotel. 
The banquet was served in the tearoom of the 



16 



THE HOSPITAL BULLETIN 



hotel, and the tables were resplendent with cut 
flowers and trailing asparagus. Dr. Harvey 
Gushing acted as toastmaster. Speeches were 
made by Dr. John C. Hemmeter, Dr. J. M. T. 
Finney, Dr. Samuel Chew and Dr. II. M. 
Thomas. Some of the invited guests were Drs. 
J. J. Abel. Hiram Woods, J. Mason Hundley, 
Jacob Bird, Joseph Hart, Jose L. Hirsh, II. C. 
Davis and T. Harris Cannon. 



Dr. Timothy O. Heatwole, class of 1897, City 
Councilman from the Twelfth Ward, who re- 
sides at 2003 North Charles street, has been con- 
fined in the University Hospital with appendicitis. 



The last meeting of the Baltimore County 
Medical Society Mas held in the hall of the Alert 
Engine Company, and was addressed by Dr. 
Hiram Woods. Among those present were the 
following of our alumni: Drs. H. D. Cox. Ar- 
lington ; William D. Corse, Gardenville ; Hiram 
Woods, Baltimore; James II. Wilson, class of 
[868, Fowblesburg; Josiah S. Bowen, Alt. Wash- 
ington; Harry G. Naylor. Pikesville : H. Louis 
Xavlor. Pikesville; E. A. Jones, Baltimore 
county; L. Gibbons Smart, Lutherville : J. M. 
Hundley, Baltimore; R. C. Massenburg, Towson. 



Dr. fohn R. Winslow has returned from Rich- 
mond, Va., where he presented a paper to the 
American Laryngological, Rhinological and Otol- 
oerical Society . 



Dr. L. J. Goldbach writes to Tin-: Bulletin: 
"My attention has been called to the fact that a 
statement in my article on the ear polyp in The 
Hospital Bulletin of the January number, is 
liable to be misinterpreted, so I respectfully re- 
c|iiest space to make matters clear. 

"The statement reads: 'Our method of treat- 
ing the aural polyps at the Presbyterian Eye. Ear 
and Throat Hospital is by means of 10 per cent, 
formalin irrigations (10 gtts. to a half tumbler 
of warm water). I had no idea of meaning that 



10 per cent, formalin could be used without dilu- 
tion : rather, one-half tumbler of warm water 
1 practically 4 oz.j, to which add 10 gtts. of a 10 
per cent, solution of formalin, this making the 
injecting fluid about 1-2000.' " 



At a meeting of the Anne Arundel County 
Medical Society, held February 9, 1909, the fol- 
lowing of our alumni were elected to office for 
the ensuing year : Vice-President, J. Oliver Pur- 
vis. M. D. ; Treasurer, Frank H. Thompson, 
M. D. ; Secretary, Louis B. Henkel, M. D. ; Cen- 
sor, J. S. Billingslea, M. D. : Delegate to the State 
Faculty, C. R. Winterson, M. D. 



At the last meeting of the University of Mary- 
land Medical Association, held in the amphithe- 
atre of the University Hospital, Tuesday, Feb- 
ruary 16, 1909, at 8.30 P. M., the program was 
as follows : 

1. The Gonococcus. Its Toxins and Paths of 
Infection — Mr. W. F. Weber, of the Senior 
Class. 

2. Systematic Infections due to the 1 ionococcus — 
Dr. Harry Adler. 

3. Treatment of Acute Gonorrhoea — Dr. Page 
Edmunds. 

4. Treatment of Chronic Gonorrhoea — Dr. W. D. 
Scott. 

5. The Treatment of Gonorrhoea in the Female 
—Dr. Flush W. Brent. 



The twenty-third annual reunion and banquet 
of the Princeton Alumni Association was held 
February 2j, 1909, at 2 West Eager street. Bal- 
timore. Among those present were the follow- 
ing of our alumni: Dr. Hiram Woods, Dr. Silas 
Baldwin. Dr. C. W. Mitchell. Dr. Hiram Woods 
was elected a member of the executive com- 
mittee. 



Dr. Fell writes: "Dr. Nathan Winslow — I am 
very much obliged for your very kind letter of 
sympathy in our recent severe loss. In many 



THE HOSPITAL BULLETIN 



1? 



ways it is irreparable, but 1 hope that one good Winslow : "I am very glad to be able to tell you 
effect growing- out of it may be a development that my wish for the appointment on the surgical 



of a strong feeling for the University of Mary- 
land, making" us of one interest and of one mind. 
The members of the other Faculties have been 
most kind in the feeling they have expressed." 



Dr. Edgar G. Ballenger. class of 1901, is editor 
of the Journal-Record of Medicine, published at 
Atlanta. Ga. 

Among our alumni subscribers to the annual 
banquet of Loyola College were the following: 
Dr. Louis W. Knight. Dr. L. J. Goldbach, Dr. J. 
J. Carroll. Dr. T. J. O'Donnell, Dr. F. A. Kirby. 
Dr. Charles O'Donovan, Dr. W. F. Schwartz, Dr. 
E. F. Milholland, Dr. L. E. Neale, Dr. M. A. 
O'Neill. 



In a letter to Professor Randolph Winslow, 
Dr. T. Rassy, class of 1902, says, in part: 
"Lately I received a letter from my nephew, 
Jenil Rassy, who is now in the University. Jenil 
thinks that the University of Maryland is ideal, 
and he is sorry he did not go there sooner. Jenil 
tells me that the University has wonderfully im- 
proved. I am very glad and happy to hear it. as 
nothing makes me more delighted than to hear 
of the progress of the dear old University of 
Maryland." He goes on to ask of the various 
instructors with whom he was acquainted, and 
continues: "Since I left Baltimore I went to 
Constantinople, where I received my Ottoman 
Permit, and then returned home to Syria, where I 
practiced privately for about 15 months. In Sep- 
tember, 1904, I joined the Egyptian Army as a 
member of the Medical Corps, and here I am still 
an officer in His Highness the Khedive's Army." 
He then says he intends remaining in the Egypt- 
ian service for at least five vears longer. 



staff of our hospital has been gratified. The 
Governor's meeting was held at a later date than 
I had supposed. I want again to thank you for 
the valuable assistance afforded me by your 
letter." 



The handsome residence of Dr. Edward A. 
Wareham. class of 1883. on Potomac avenue. 
Ilagerstown. was destroyed by fire Februarv 4, 
1909, entailing a loss of $20,000, partially cov- 
ered by insurance. Dr. YVareham's three chil- 
dren were compelled to flee from the burning 
building in their night clothes. The fire, which 
started in the attic, was thought to be due to 
crowed electric wires. 



Dr. James S. Fox, class of 1907, of Charleston, 
S. C, a former house student and ex-resident in 
the obstetrical department, has been appointed a 
lieutenant in the Medical Corps of the United 
States Army. He was one of the 14 successful 
out of a total of 56 candidates at the recent ex- 
aminations for entrance to this branch of the 



Dr. J. Holmes Smith has been appointed sur- 
geon to the United Railway service connected 
with the University Hospital. 



Dr. 11. M. Fitzhugh, class 1897, now practicing 
his profession in Westminster, Md., with success, 
has been a recent visitor to the University Hos- 
pital. Dr. Fitzhugh was formerly a resident phy- 
sician to the Hospital, and he enjoys his visits to 
his former haunts. 



Dr. T. S. Latimer, class of 1907, is now a suc- 
Dr. Arthur E. Ewens, class of 1904, of At- cess ful practitioner in I lyattsville. Md. Dr. Lat- 
lantic City, N. J., writes Professor Randolph inier recently visited the Hospital. 



18 



THE HOSPITAL BULLETIN 



Dr. Alexander D. McConachie has been ap- 
pointed eye and ear surgeon to the Union Hos- 
pital of Cecil county, at Elkton, Md. 



Dr. J. J. Taylor, class of 1908, of Madison, 
N. C. ; Dr. John Bizzill, class of 1908, of Tampa, 
Fla. : Dr. Keavy Pearlstine, class of 1906, of 
Charleston. S. C. and Dr. John S. Kerr. Jr., class 
of 1908. of Wilmington, N, C. have been recent 
visitors to the University Hospital. These recent 
graduates of the University believe that an occa- 
sional visit to nlma mater is beneficial in many 
ways. 



The Bulletin is always glad to see the alumni 
of the University around the Hospital. It is a 
good sign when our former students come back to 
the Hospital to freshen up their clinical work. 



The final meeting of the Executive Council of 
the Centennial Committee was held at the resi- 
dence of Prof. John C. Hemmeter on Tuesday, 
March 9. The object of the meeting was to audit 
the accounts of the treasurer. After the paying 
1 if the cost of publishing the Centennial Volume 
and the designing, casting and erection of the 
James Carroll memorial tablet, there was reported 
a small balance in the Calvert Bank. 

The auditing was done by Dr. B. Merrill Hop- 
kinson. Dr. T. O. Heatwole and Dr. I. II. Davis. 
The committee voted that the small balance 
should be left at interest in the Calvert Bank in 
order to defray expenses of sending the Cen- 
tennial Volume to the university libraries of 
this country. Canada, Europe, etc. 



Daisy Yarbrough, of Staunton, Va., were mar- 
ried in the First Presbyterian Church, at 
Staunton, recently. They will reside at Maple- 
wood. X. J., where the groom has been prac- 
ticing medicine for several years. 

Tlie Virginia papers described the Ranson- 
Yarbrough wedding, which was celebrated at 
Staunton, Ya., on Thursday, February 4th, as 
being one of the most beautiful of the season. 

The contracting parties were Miss Daisie Yar- 
brough, of Staunton, and Dr. B. B. Ranson, Jr., 
of Maplewood, N. J. The wedding ceremony 
was performed at the First Presbyterian Church 
at 6 o'clock, and the decorations were simple, but 
most effective, being composed entirely of hand- 
some palms and white candles. A brilliant re- 
ception was given at the home of the bride, and 
later Dr. and Mrs. Ranson left on an extended 
tour. They will reside in Maplewood. 

Dr. Ranson graduated in the Medical Depart- 
ment, class of 1902. He was a man of great 
popularity, and has since attained marked suc- 
cess in the practice of his profession. 



Dr. F. Garnett Cowherd, class of 1908, of 
Mount Savage, son of Mr. and Mrs. William 
Cowherd, of Cumberland, and Miss Amie 
Louise Perdew, daughter of Prof, and Mrs. 
George M. Perdew, were married this evening 
at the home of the bride by Rev. William 
Cleveland Hicks. Miss Ruth Perdew was 
bridesmaid and Mr. Algernon Hardy, of Wash- 
ington, a cousin of the groom, was best man. 



DEATHS. 



MARRIAGES. 



Dr. Harry T. Talbott, class of 1887, son of 
Mr. and Mrs. H. O. Talbott, died at his home 

February 26, 1909, after an illness of some 

Dr. Briscoe Ranson. class of 1902, son of Dr. weeks, aged 42. He is survived by one daugh- 
B. P>. Ranson. of Harpers Ferry, and Miss ter — Miss Lillian Talbott — and one sister— 



THE HOSPITAL BULLETIN 



19 



Mrs. John F. Buckner, of Washington. Dr. 
Talbott's wife, who was Miss Lillian Hedges, 
of Frederick, died some years ago. His body 
will be interred in the latter place. 



Dr. J. H. W. G. Weedon, class of 1864. one 
of the most widely known physicians of the 
Eastern Shore of Maryland, and once a mem- 
ber of the Legislature, died Wednesday, Feb- 
ruary 17, 1909, of Bright's disease, at the Uni- 
versity of Maryland Hospital. Dr. Weedon 
was 74 years old. and lived at Church Hill. 
For two weeks Dr. Weedon had suffered 
acutely from Bright's disease, and recently de- 
cided to come to the University Hospital. Dr. 
Weedon weakened steadily, and died about 
1.30 o'clock in the afternoon. 

Dr. Weedon ws born on Kent Island. Sep- 
tember 1. 1835, and was the son of the late 
Henry and Rebecca I. egg Weedon. He studied 
medicine and was graduated from the Univer- 
sity of Marylandj after which he returned to 
Kent Island, where he practiced and became 
interested in politics. He represented the Dem- 
ocratic party in the Legislature of 1882. In 
1885 he left the island for Church Hill, where 
he devoted most of his time to practice. His 
only immediate survivor is his widow, who 
was formerly Miss Mary R. Thompson. The 
body will be taken to Church Hill for inter- 
ment. 



Dr. Edmund G. Waters, class of 1853, OI Bal- 
timore, 79 years old, 1711 Madison avenue, 
died recently. He was the son of Dr. Francis 
Waters, of the Methodist Protestant Church, 
and was born in this city. Dr. Waters studied 
in the office of Dr. Nathan R. Smith, and was 
graduated from the University of Maryland in 
the class of 1853. He married the daughter of 
Dr. William Hitch, and he first had an office 
on Hollins street, where he engaged in the 
practice of his profession. When the Civil War 
broke out Dr. Waters was appointed assistant 



surgeon at the Camden Hospital, and served 
there and at Jarvis. Me afterwards became 
professor of chemistry at the Baltimore High 
School, remaining there until he moved to 
Dorchester county, near Cambridge, in 1868. 
In 1882 he returned, and again engaged in prac- 
tice until the breaking of his leg incapacitated 
him from active work. 



Mrs. Xorris. wife of Dr. J. B. Norris, class 
of 1866., sanitary officer of the Sixth district, 
died recently at her home, at Beckleysville. 
She is survived by her husband and two daugh- 
ters. Before her marriage she was Miss Gard- 
ner. 



Dr. Edmund Cantwell Gibbs, of Baltimore, 
died at his home, 316 East North avenue, as the 
result of Bright's disease. Dr. Gibbs was born 
near Middletown, Del., on September 17. 1856 
He was the son of the late Benjamin and Hannah 
Justice Gibbs, of Delaware, and descendants, re- 
spectively, of early English and Swedish settlers. 
After leaving the Middletown Academy, in Dela- 
ware, Dr. Gibbs took up pharmacy. After several 
years of work at this profession he came to Balti- 
more and entered the Medical Department of the 
University of Maryland. He was graduated in 
1884. 

In the last year of his collegiate course Dr. 
Gibbs was resident student at the University Hos- 
pital, and for several years was surgical dis- 
pensary assistant. He was a member of the 
Medical and Chirurgical Faculty of Maryland 
and medical examiner of the Shield of Honor. 

Besides his wife, Mrs. Lulu C. Gibbs, Dr. Gibbs 
is survived by five children — Joseph S. Gibbs, of 
Wheeling. W. Ya. ; Isaac Gibbs, of Kent county; 
Anna Dale, Gustavus J. and Catherine J. Gibbs. 
The funeral services will be held at the late home 
of the deceased tomorrow afternoon at 2 o'clock. 
The body will be taken to Middletown. Del., 
where burial will be in the family graveyard in 
Old St. Ann's Churchyard. 



I N PNEUMONIA the- inspired air should be rich in oxygen and ccm- 
■i[ paratively cool, while the surface of the body, especially the thorax, 
should be kept warm, lest, becoming chilled, the action of the phagocytes 
in their battle with the pneumocoeci be inhibited. 




(Inflammation's cAntidote) 

applied to the chest wall, front, sides and back, hot and thick, stimulates the 
action of the phagocytes and often turns the scale in favor of recovery. 

Croup. — Instead of depending on an emetic for quick action in 
croup, the physician will do well to apply Antiphlogistine hot and thick from 
ear to ear and down over the interclavicular space. The results of such treat- 
ment are usually prompt and gratifying". 

Antiphlogistine hot and thick is also indicated in Bronchitis and Pleurisy 



The Denver Chemical Mfg. Co. 



INe-vv York 




ERTAIN as it is that a single acting cause can bring 
about any one of the several anomalies of menstrua- 
tion, just so certain is it that a single remedial agent 
— if properly administered — can effect the relief of 
any one of those anomalies. 
<]] The singular efficacy of Ergoapiol (Smith) in the 
various menstrual irregularities is manifestly due to its prompt 
and direct analgesic, antispasmodic and tonic action upon the 
entire female reproductive system. 

^ Ergoapiol (Smith) is of special, indeed extraordinary, value in 
such menstrual irregularities as amenorrhea, dysmenorrhea, 
menorrhagia and metrorrhagia. 

<J The creators of the preparation, the Martin H. Smith 
Company, of New York, will send samples and exhaustive 
literature, post paid, to any member of the medical profession. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 

PHICK Sl.OO PER YEAR 



Contributions invited from the Alumni of the University. 
Business Address, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter. 



VOL. V 



BALTIMORE, MD., APRIL 15, 1909 



No. 2 



THE ETHICS OF THE GENERAL PRAC- 
TITIONER. 

An Address delivered Before the University of 

Maryland Medical Association, 

March 16, 1909, 

By Guy Steele, M. D. 
Of Cambridge, Md. 

A celebrated divine once said that the most 
difficult part of a sermon was the selection of a 
proper text. I must thank the President of 
this society for saving me this trouble. When, 
however, Webster's is consulted for a proper 
definition of the word "Ethics," and it is found 
to mean "The science of human duty," it 
would seem that he has chosen a text almost 
too comprehensive for the limits of a short 
paper, even when restricted to the "ethics of 
the medical profession." It may not be out of 
place to thank him for the honor he has con- 
ferred upon me by deeming one whose student 
days are scarce twelve years behind him 
worthy of presenting this subject to you, for a 
paper on this topic is almost of itself a sermon, 
and we naturally look up to those, whose many 
years of experience and works have brought 
them prominence, for instruction in morals and 
duty. Still, I take it, whether young or old, all 
of us like to preach on fitting occasions, and 
not the least part of the inspiration to effort is 
the character of the audience. My invitation 
was to read a paper before the Clinical Society, 
and incidentally I was told that some of the 
students had expressed a desire to be present. 
Little, however, did I anticipate such a flatter- 
ing attendance from them when examination 
time so nearly approached, and it is evidence of 
a most commendable spirit when they can 
bring themselves to take even an hour of their 
most valuable time from study to devote to a 
consideration of the moral duties and responsi- 
bilities which shall be theirs when they shall 
have passed through the April ordeal. Much 
that I have to say tonight will be directed es- 
pecial!}' to them, and if they or their elders in 



the profession may in the years to come look back 
upon this night with the recollection that I 
have more forcibly brought to mind some of 
the old and half-forgotten maxims and axioms 
that make for a better and purer professional 
life, I will have been more than repaid for the 
time I have expended in the preparation of this 
paper. 

In discussing the ethics of the general prac- 
titioner towards his patient, I would have you 
remember that your first and most important 
duty is to give to those who trust you the very 
best that is in you. 

To you young men, full of enthusiasm for 
your new profession, and imbued with Utopian 
ideas of the mission which you have under- 
taken for the good of mankind, it would seem 
almost foolish for me to mention this as the 
first advice I would offer you. But I think I 
can see a smile of understanding flit across the 
faces of those who have for some years fought 
the battle of life, and who have had the wire 
edge of early ambitions and determinations 
blunted by contact with unappreciative 
patients and unworthy professional competi- 
tion and the daily incidents of a busy life. They 
know that it is very easy to feel too tired, or be 
too busy, or have some other engrossing affair 
in mind which prevents that entire devotion to 
duty which all admit is essential to success in 
medicine. Half of success in life or in any un- 
dertaking is due to a successful start; there- 
fore, let me ask you to firmly determine on one 
or two fixed principles, and to stick to those 
principles through thick and thin. Be fully as- 
sured that no halfway devotion to your profes- 
sion will ever bring you prominence or success. 
The time-worn phrase that "Medicine is a 
jealous mistress" loses none of its truth by fre- 
quent repetition. Recently I saw in a promi- 
nent medical journal the advice given that cloc- 
tors should take a prominent part in politics 
and bring themselves forward in other ways, 
and that therebv in some way unknown to me 



22 



THE HOSPITAL BULLETIN 



the glory of the profession would be enhanced, 
and much benefit result to the community. Far 
be it from me to discourage a proper civic 
spirit and a proper interest in public affairs, or 
to advise an avoidance of any duty which good 
citizenship imposes upon every honest, patri- 
otic man, whatever his business or profession. 
But I take it that no more baneful, no more 
dangerous advice can be given to our young 
professional man than this. You cannot be 
successful in both politics and medicine, and 
while we can point to one member of our pro- 
fession in the United States Senate, and to 
some notable exceptions in our own State, 
where men of our profession have, for a time, 
abandoned medicine and returned to it to win 
success, you can rest assured that the medical 
politician possesses little beyond a musty 
diploma to remind the world that he was once 
of our cult. So don't be a halfway politician 
and halfway doctor. Success in either field 
will take all of your best effort and all of your 
time. 

What I have said of politics will apply, 
though not quite so forcibly, to any other en- 
grossing business or pleasure. Time forbids 
me to elaborate this idea, and in concluding it 
let me say that you cannot be a successful poli- 
tician, merchant, sport or what not and carry 
medicine as a side line. 

It may seem useless to remind you that, in 
order to give the best that is in you, you must 
keep abreast with what is new and best in pro- 
fessional literature and scientific progress. You 
all have determined to be students, and even 
those who pride themselves on having passed 
through the University without having opened 
a book have a half-formed desire to really 
know something beyond spotting a possible ex- 
amination question, and when once examina- 
tions are over, and they have reluctantly with- 
drawn themselves from the delights of the city 
by gaslight for the pine woods and mountain 
trail, they will burn the midnight oil and 
browse diligently through their musty tomes. 
May I tell you that nothing is harder than to 
find time for study. Many of us, even though 
city men, with the best and latest literature at 
our elbows, are ashamed to think how thor- 
oughly we abhor the sight of a medical book 
or magazine, and how easily we can persuade 
ourselves that we are too tired and stale, and 



so engrossed during the day with scenes of 
sickness and suffering that we must have our 
brief hours of release from duty for recreation. 
We do need our hours of relaxation and rest 
and our too infrequent holidays, and they are 
absolutely essential to good health and good 
work. Don't, however, confuse the words rest 
and relaxation with sloth and idleness, and 
don't think your professional work completed 
when your round of daily visits is done. In- 
deed, if you would know medicine you must 
woo your mistress in the small hours of the 
night, and in many of the leisure moments that 
the day may bring you. 

Much has been spoken of the man who prac- 
tices by common sense, and whose school has 
been that of observation and hard experience. 
A most worthy brother he is at times, and 
many are his friends and wonderful his suc- 
cess. But if the science of medicine is to ad- 
vance, more is required for progress than mere 
common sense, and observation untrained and 
experience undirected and unguided by the ob- 
servation and experience of others will rarely 
discover a new bacillus or elaborate a side 
chain theory. So, to be truly ethical in the 
duty you owe to give the best that is in you, 
you should be reading men. Take one or more 
of the medical journals. Buy for reference the 
latest and best text-books. Make the opportu- 
nity to read the daily papers and something of 
current literature. A well-rounded man can 
afford to do nothing less. Besides the infor- 
mation you obtain, it pays in the respect of the 
community to have the reputation of being 
posted in your profession. Often the country 
man simply hasn't time at home to read. A 
busy life, with its miles upon miles of dusty 
roads to travel, precludes all chance for the 
easy chair. Then cultivate the habit of reading 
while driving. Many are the useful and happy 
hours I have spent in my carriage with my 
journals and magazines. I am frank to say 
that, but for this habit, I never could have 
found time for one-half of the reading I have 
done. Last year I was somewhat amused 
when a most worth}', well-educated and well- 
posted man summed up his opinion of another 
by saying that he was one of those who read 
magazines in his carriage. If I mistake not, 
this indictment was brought against the late 
Dr. Miltenberger, who as a young and busy 



THE HOSPITAL BULLETIN 



23 



man was forced to form this habit, and I could 
but think that, could I die with half the honor 
and respect and love that were his, I could 
plead guilty to even this mark of devotion to 
my profession and desire to advance in it. 

Would you be ethical in giving the best that 
is in you to your patients, you must give un- 
grudgingly of your time. This may again seem 
a useless piece of advice, and yet almost all of 
us are familiar with the man whose motto is 
"Veni, Vidi, Vici" — "I came, I saw, I con- 
quered." This intuitive diagnostician is by no 
means a myth. The man who comes in a rush 
and goes in a rush, and who, with pencil in one 
hand and prescription pad in the other, feels 
the pulse while the thermometer is under the 
tongue ; who sees at a glance, without neces- 
sity of personal or family history or of physical 
examination, just what is the matter, and who, 
giving four or five prescriptions, rushes out, 
trusting that something in his shotgun therapy 
may hit the enemy. Perhaps the next day he 
prescribes four or five more remedies or combi- 
nation of remedies, and should the patient be- 
gin to improve, prides himself that he has made 
and confirmed a diagnosis by his experimental 
therapy. Is it necessary for me to say that no 
ethical man with any regard for the rights of 
his patients and his obligation to his profession 
can really practice medicine in this manner? 
The plea that you are too busy to give the 
proper time to your cases is no justification for 
your neglect. Anything less than a careful in- 
quiry into family and personal history, fol- 
lowed by a painstaking and thorough physical 
examination, is unjust to your patient and un- 
just to yourself. No ethical man can give the 
best that is in him by doing less than this. If 
you haven't the time to do your work thor- 
oughly, make a clean breast of the matter and 
take fewer cases. But you will say that a man, 
even in large practice, cannot afford to give 
any of it up. He needs every dollar that hon- 
estly comes his way, and to say that he hasn't 
time for his work is only another way of throw- 
ing practice into the hands of a rival. This is, 
indeed, a proposition hard to solve, as most of 
us do need every dollar that honestly comes 
our way; but if our work is only half done, if 
we have neglected some important point in diag- 
nosis, and thereby omitted some equally important 
measure in treatment, have our dollars been 
honestly earned? Let us start out with and 



carry in mind this axiom of a truly ethical life, 
that success in medicine cannot be measured 
by commercial success ; that, while no sensible 
man can neglect the business side of his voca- 
tion, or refuse to demand and collect just com- 
pensation for his service, such compensation 
cannot be measured in dollars and cents alone ; 
that a good conscience and whole-souled devo- 
tion to duty, giving ungrudgingly of the very 
best that is in you to those that have confided 
in you, will be your very best asset when the 
final account is made up. 

May I impress the fact upon you that an eth- 
ical man, with a just appreciation of his duty 
to his patients, can never be a vendor of patent 
or unofficial medicines. Indeed, I would be 
lacking in my duty if, with the opportunity this 
paper offers me, I did not, from the standpoint 
of experience, impress upon you with all of the 
force at my command the necessity of being 
wary of the detail man and the alluring adver- 
tising literature with which your mail will be 
flooded. You will scarcely have opened your 
office, and be waiting with what patience you 
can command that rush of the halt, the lame 
and the blind to which you feel that your tal- 
ents entitle you, before the suave detail man, 
having heard of the new field, puts in his ap- 
pearance. What you lack in therapeutic ex- 
perience he can supply you by drawing liber- 
ally on the experience of others who have 
worked little less than miracles in an adjoining 
town by the use. of his pills and potions, his 
elixirs and tinctures. You will find him smooth 
and oily, placid and plausible. He knows his 
story well, and even by his much speaking can 
almost persuade you that what you knew, or 
thought you knew, or what you had recently 
been taught, were all out of date ; that by some 
stroke of genius the chemist of his house had 
discovered some way by which compatibles 
would combine with incompatibles into the for- 
mation of a new and staple mixture, possessing 
all of the virtues and none of the defects of its 
original constituents, rendering chloral as 
soothing as the strings of a lute and as harm- 
less as the cooing of a dove, extracting from 
cod-liver oil every disagreeable feature and 
leaving nothing but its supposed virtues be- 
hind. He will show you the short road to for- 
tune and success. Treat him kindly; the ethical 
man should not be rude, and brusqueness is 
not a sign of Roman honesty or virtue. Be as- 



24 



THE HOSPITAL BULLETIN 



Sured he feels his position keenly, and is dread- 
ing the catechism which will sooner or later 
display his ignorance of everything but the 
story that has been drilled into him like a 
parrot. 

There has been no greater shame in our pro- 
fession than the influence these men and their 
houses have exercised, and incidentally the in- 
dorsements and recommendations that 
thoughtless men have furnished them. The 
blame is all ours, and we cannot shun it. We 
pride ourselves on our scientific attainments ; 
that we take nothing for granted ; and, now 
that the age of empiricism has passed, we ac- 
cept nothing that does not bear the stamp of 
scientific approval. And yet, before the cam- 
paign of the American Medical Association and 
the revelations of Collier's and the Ladies' 
1 [•mie Journal, we accepted our treatment from 
the hands of the manufacturing houses, and 
dosed our patients with nostrums about which 
we knew nothing except the statements of 
those whose sole purpose it was to sell. There 
are few of us who have been many years in 
practice to whom a blush of shame does not 
come at the recollection of our gullibility and 
our guilty innocence. Can any man deem it 
ethical to give even to a good dog something 
about which he was totally ignorant? And yet 
this is just what we were doing. A short time 
ago a particularly shrewd detail man was dis- 
cussing this very point with me, and claiming 
that, as the formula was now required by law 
to be printed in each bottle and package, this 
most formidable objection could not now hold 
good. Handing me a bottle of his patent cure- 
all, he glibly called my attention to the six or 
seven ingredients, with the amount of each 
contained in the fluid ounce. Among other 
potent quantities I can recall 1-48 gr. of mor- 
phia and 1-240 gr. of strychnia. The dose was 
a teaspoonful three times a day. Any man can 
imagine the more than homeopathic effect of 
1-4S gr. of morphia divided into eight doses. 
These well-known and well-tried drugs were 
not. however, the life of the nostrum, and pres- 
ently we came to the twenty minims to the 
fluid ounce of the fluid extract of the drug from 
which the remedy derived its name. Something 
I had never heard of. Something unlisted in 
the U. S. P. Something discovered and owned 
and controlled by this house alone. As my ig- 



norance became more apparent his eloquence 
increased, and I have no doubt that a few years 
ago, before my moral conscience had become 
aroused to the therapeutic sin of prescribing 
something whose botanical family, whose 
chemical formula, and even whose physiologi- 
cal effects were totally unknown to me, I would 
gladly have accepted a sample and would have 
tried it on some poor soul too poor to pay 
for a prescription. It is nothing short of a 
shame to think of what we have done in this 
line. The sin has been one of carelessness and 
laziness rather than of ignorance. Here we 
had ready to hand some remedy, beautiful to 
the eye, palatable to the tongue ; then why take 
the time and trouble to bother about construct- 
ing a formula of our own when someone else 
of equal experience had constructed one for 
us? I am ready to thank God that most of 
these nostrums are as harmless as they are 
beautiful, and, while I may not have done good, 
I rarely did harm by their use. I am not dis- 
cussing the opium and cocaine laden classes. I 
wish to emphasize incalculable harm that must 
result to the physician himself who allows 
someone to do his thinking for him. I am also 
referring to the attitude of the ethical man to 
his patient, and beg to ask if we are doing even 
part of our duty when we are doing no harm. 
Allow me to conclude this topic by asking you 
to spend an hour some day in casually glancing 
over (a deep study would fully repay you) the 
pages of the U. S. P., or a list of the remedies 
that have in one year received the sanction of 
the Council on Pharmacy of American Medical 
Association. If you don't find enough drugs 
and combinations to meet every case and every 
conceivable situation, you had better desert 
practice and exploit some wonderful cure-all 
as a detail man. 

If we, as physicians, had nothing but our 
duty to our patients to consider, and inciden- 
tally our own profit and glory, the practice of 
medicine would soon degenerate into a mere 
trade. I may even say that, had we nothing 
but the promptings of our consciences to keep 
us in the straight and narrow path, if we had 
nothing but the knowledge of work well done, 
and if the desire and determination to give the 
best that is in us were our only incentives to an 
ethical life, the profession would be so beset 
by the temptations of commercialism, and the 



THE HOSPITAL BULLETIN 



25 



notoriety and prominence which commercial 
success brings, that the halls of Esculapius 
would soon need a scouring and purging great- 
er than Hercules gave the Augean stables. De- 
spite the high incentive to all that is best and 
purest in life which our noblest of callings 
should beget in us, physicians are only human, 
and human weakness, like disease, is no re- 
specter of persons or of callings. It may have 
been that the medical fathers, with a knowl- 
edge of the temptations to which they were 
subjected, and a desire to save others from the 
pitfalls which beset their paths, were imbued 
with a determination to place their profession 
on a higher plane than others ; or it may have 
been the natural evolution which inevitably re- 
sulted from and followed the promptings of 
man to help his fellow-man, to devote himself 
to the relief of pain and sickness, to sacrifice 
his comfort and ease and almost every pleasure 
in order that others might have ease of body 
and peace of mind and soul, which from the 
earliest days have placed medicine as a profes- 
sion apart, and have imposed upon those who 
have entered its ranks certain standards of con- 
duct and insisted on certain ethical relations 
which have lifted it above mere questions of 
gain and the vain acquisition of renown. We 
have been taught that Hippocrates himself was 
great not only as a physician, but greater still 
as an ethical teacher who has left with us cer- 
tain maxims and proverbs which, though 
handed down through the ages, have lost none 
of their truth and none of their spotless moral- 
ity. Even in the Middle Ages, when learning, 
not to say science, had sunk into such an abyss 
of ignorance that the ability to write one's 
name lifted one into the ranks of the educated, 
when human ills were relieved more often 
with the sword than with the scalpel, the leech 
was a man apart. His education, his scientific 
investigations, and even his supposed commu- 
nion and partnership with the evil one, placed 
his on a pedestal above other professional call- 
ings. Then, as now, though men might scoff 
at our profession of superior knowledge and 
skill, when "pallida mors" stalked abroad or 
knocked at the hovels of the poor or palaces of 
the rich, all arose to call us blessed. It has 
been often said that, could a medical man live 
up to the ethical standards of his profession, 
his chances without creed or priest would not 



be small at the last great day. But with all of 
our high ideals we are only mortal, and we 
know and have sorrowed at the fact that many 
of our ethical standards are not lived up to, and 
that the Hippocratic law is frequently more 
honored in the breach than in the observance. 

We have in every community where one or 
two are gathered together in the name of medi- 
cine the man who is everything to your face 
and everything else behind your back; who 
damns by faint praise ; who sympathizes with 
you in your sorrows and trials, who visits the 
family of the patient you have lost to assure 
them of your skill and to insist that everything 

was done that could have been done, "but" 

and that one harmless little conjunction, mean- 
ing nothing in itself, is more eloquent than a 
thousand terrible adjectives or burning, blis- 
tering adverbs or participles. So many things 
can be said by the pious uplifting of the eyes, 
the sanctimonious upturning of the palms. He 
would not for the world leave a doubt in the 
minds of your people, and, no matter what in 
his inmost heart he thinks of your mistakes 
(from his standpoint), it is not his place to in- 
jure a brother, but, alas! he is not responsible 
for the unguarded tongues of his friends, and 
he usually sees that they do his work well for 
him. Often it is "if I could only have reached 
him earlier," which, being interpreted, means 
a miracle would have been wrought. Almost 
every community has its miracle worker, its 
medical resurrectionist. His cases are always 
a little worse than others, his victories a little 
more wonderful. Where you have a bronchitis, 
he has a desperate pneumonia, your transitory 
albuminuria is with him acute Bright's, and 
hopeless cases follow him to undo him, only 
to meet defeat at his skillful hands. You hear 
that Mr. A. is desperately ill with pneumonia 
on Monday, and on Friday you meet him on 
the street, looking hale and hearty, firmly be- 
lieving that, had Dr. X. been one hour later in 
reaching him, he would ere this have been gath- 
ered to his fathers. Should you mildly suggest 
that some error in diagnosis might have been 
made, that even the best of us at times go 
wrong, and that resolution in true pneumonia 
could hardly be expected in four days, you will 
find that he has been prepared for you, feeling 
that Dr. X. has used some potent remedy as 
yet unknown to you and his less skillful breth- 



26 



THE HOSPITAL BULLETIN 



ren, and firmly convinced that your suspicions 
of his case are based upon your ignorance or 
your jealousy of poor Dr. X., who was not 
there to defend himself, who had always spoken 
so kindly of you, and had uttered nothing 
worse than the harmless little conjunction 
"but" 

A little bragging is not a sin, and indeed is 
usually harmless, and in the long run reacts on 
the miracle worker. But the ethical man does 
frequently suffer from it, and it is a fact, ab- 
surd as it may seem, that the average man or 
woman would much prefer to be considered at 
death's door about three-fifths of the time — in- 
deed, almost a walking Lazarus — than to be 
deemed the picture and personification of vig- 
orous health. Dr. X. knows this, and plays 
upon the credulity of his patients. He fright- 
ens them to death's door, works a miracle, and 
has tied them to himself forever. We all have 
suffered from this, and will continue to do so 
until the little grain of truth has grown from 
the tiny mustard seed to the vigorous bush. 
Dr. X., with his faults, has his virtues. He as- 
pires to be the busiest man, the richest man, 
the most popular man in his community. xA.ll 
of these ambitions, if properly guided, are 
laudable, and, indeed, while enhancing his 
power and prestige, may be redounding to the 
good of his people, for a man to be the busiest 
and most popular man in his profession must 
usually be the best posted, the most highly ed- 
ucated, the hardest working man, not only for 
himself, but for those he serves. So, while we 
may smile at Dr. X. and his big ways, we may 
love him for his virtues and forgive his small 
faults. 

But for the man who deliberately goes to 
work to undermine another; who takes advant- 
age of some temporary absence of the regular 
physician to ingratiate himself ; who, appre- 
ciating the fact that people worried nearly to 
death by the illness of a loved one, will forget 
every obligation and desert every old friend in 
the hope that the new one may offer some en- 
couragement or extend some hope, is ready for 
these emergencies. He carries satchels full of 
hope for all cases and occasions. He prescribes 
it liberally, diluted, however, to the point of de- 
spair because he was called in an hour too late, 
or because the case had already been damaged 
beyond his power of repair. This gentleman 



advances not only by his own deceit, but uses 
the power of church, of politics, of family influ- 
ence and social opportunity, to lift himself 
along. Verily he has his reward, but it is not 
in peace of mind, not in the honor and respect 
of his community, but the contempt of every 
honest man, be he of the profession or laity. 
Not the least of the perplexing questions which 
beset the man who is trying to lead an ethical 
life is his duty in his relation as consultant. In- 
deed, there is scarcely a situation in profes- 
sional life that at times presents more embar- 
rassing possibilities, or calls for the exercise of 
more tact. It is a pleasure to be able to bear 
witness to the ability of the man who has called 
you to his aid, to assure the family that every- 
thing has been done that care in diagnosis and 
skill in treatment could demand. But what of 
the cases where gross carelessness or blind ig- 
norance have hastened what might easily have 
been delayed or averted? There is only one 
way here, only one duty. Treat the man as his 
carelessness or his ignorance deserves. Again, 
you are called in consultation with a thoroughly 
good man who has given ungrudgingly of the 
best that is in him. Perhaps your superior skill 
in certain lines, perhaps your superior opportu- 
nity to observe a certain line of cases, have 
taught you something that he has not had the 
chance to learn. As before it was your duty to 
expose the careless ignorance of one, now it is 
your place to so give your opinion and explain 
your position that no possible reflection can be 
cast upon the other. Don't approach a consul- 
tation with the manner of a priest of Delphi. 
Don't pose as the fountain of all wisdom and of 
all experience. Indeed, in this work you will 
be surprised how often you will learn from him 
you are called upon to assist. He has seen the 
case for days, where you can spend but minutes 
with it. It is his part to bear the blame, yours 
to share his fame should success crown your 
combined efforts. 

Frequently you will be called upon when a 
resort to surgery is demanded — not so much to 
perform the operation as to give your opinion 
as to the advisability of a certain line of pro- 
cedure. Having determined what is to be done, 
don't assume the place of prominence. You 
have little by way of reputation to gain by 
performing an operation that you were known 
to be competent to perform or you would never 



THE HOSPITAL BULLETIN 



27 



have been called. Let him do the work with 
your assistance and advice. In this way you 
will have gained a fast friend for future consul- 
tations, and you will have enshrined him in the 
esteem and confidence of his people. Therefore, 
help him and uplift and bear witness to his 
worth, and don't humiliate him by your airs 
and assumed superiority. 

As a last word, don't consult with an un- 
worthy man, for be assured that your reputa- 
tion is worth more to you than any consulta- 
tion fee, however badly you may think you 
need it. 

The question of fees is one that must be con- 
sidered. We hate to think of the combination 
of medicine and money, and our patients abhor 
it even more. The days once were when only the 
sons of the rich sought the liberal professions. 
It was thought unworthy in the days of the dim 
ages for a pupil of Esculapius to charge for his 
services. Any remuneration that came to him was 
an offering of gratitude — indeed an honorarium 
which might be tendered or withheld at the will 
of the patient. A truly noble conception this, 
that the good we offered was beyond a mere 
question of price. Equally comforting was the 
belief that the ill which resulted despite our best 
efforts was no reflection on our skill, but an evi- 
dence of the wrath of the Gods. Would that we 
were as near Olympus now as then, and that the 
Gods walked with men to reward the worthy and 
punish the unjust. Would also that the manners 
and costumes and climate of Ancient Greece were 
still with us, so that man need take little heed of 
raiment beyond a robe and sandals ; that he re- 
quired no expensive outlay for instruments, no 
intricate electric outfit, and no automobile. What 
a life ours would be if now as then our grateful 
patients sought us, and we passed our many 
hours of leisure in eloquent discussion or in lazy 
lounging amid the leafy groves or shaded por- 
ticos of the temples ! But the times have 
changed, and we have changed with them, and 
abhor as we will the combination of medicine 
and money, we are forced to take thought of the 
morrow and to spend many, many anxious mo- 
ments in this thought and in trying to evolve 
ways and means by which a balance can be main- 
tained between the honoraria of patients, both 
grateful and ungrateful, and the claims of per- 
sistent creditors. Perhaps it is best thus, as the 
average man needs some incentive to good work 



beyond the acquisition of honor and glory. An 
axiom in the question of fees is this, that in order 
to be respected we must respect ourselves, and 
no one can respect himself unless he holds his 
calling above a trade and bases his charges upon 
this feeling of respect for himself and his pro- 
fession. This axiom should be held in mind in 
arranging any fee table, and should be insisted 
upon in our settlements with those who think a 
doctor's bill should be discounted from one- 
quarter to one-half. I have often wondered how 
this right to a discount in a doctor's bill ever got 
such a firm hold in the public mind. Perhaps the 
city man cannot appreciate this fact like his 
country brother. The poor, honest old farmer, 
part of the bone and sinew of the land, expects 
the highest cash price for everything that he sells. 
If anybody has ever heard of one who when ten 
barrels of corn at $3.50 per barrel comes to $35, 
offering to take $25 for his bill, he should corral 
and cage this rara avis. But hundreds of us 
from the rural districts have been deemed mean 
and close-fisted and extortionate because we 
gently insist that $35 worth of professional serv- 
ices rendered are worth $35 and not $25. 

This is largely our own fault, for so many of 
us present a bill in one hand and an apology in 
the other. We collect our bills not as if they 
were our just dues, but with a half-hearted in- 
sistence, inducing our debtor to believe that we 
have scruples ourselves as to the value of our 
services, and that a liberal discount from the face 
of the bill will about bring us to a fair settle- 
ment. It will be better for all — for patient as 
well as physician — to realize that the "science of 
human duty" implies a duty to oneself as well as 
a duty to the public, and that a small proportion 
of the charity of our profession should begin at 
home. To the young men I would especially 
give this advice : Having settled on a fair and 
honest fee for your services, do not depart from 
this fee. With us, as a rule, prosperity in the 
form of a numerous clientage comes sooner than 
to the other professions. You will not long have 
opened your office before you will be surprised 
at the number who demand your services. There 
will be no doubt of the demand, for those who 
pay the least invariably demand the most. Don't 
turn them away, for if you properly employ your 
time, you will gain in experience and occasionally 
a dollar or two. You will soon be enlightened as 
to your popularity, for the first pay day will send 



28 



THE HOSPITAL BULLETIN 



most of them to another and it is presumed easier 
man. Many of those who stick will tell you that 

Dr. never charged but 50 cents a visit, when 

the regular fee is $1.00. Dr. will vigorously 

deny this and produce his books to prove his 
truth. Here is everything plain before you. 
Every visit is listed at the established figure. You 
will rarely see his cash book, for then the whole 
transaction would be plain, and you would dis- 
cover the simple manner by which in every com- 
munity some supposedly ethical man is supplant- 
ing his truly ethical brother by charging full fees 
and settling for half. 

Dr. will cut 50 cents or a dollar from the 

established fees for out-of-town work, and im- 
mensely increase his practice by it. For be it 
understood the bone and sinew of the land dearly 
love the wholes and halves, and will flock to sell 
in the dearest and pay in the cheapest market. 
Don't envy this man his prosperity and, above 
all, don't follow in his footsteps. Bide your 
time with the assurance that the man who charges 
$1.00 for $2.00 worth of service rarely gives 
more than a dollar's value, and that when a real 
emergency arises and a capable, honest man is 
demanded, one who respects himself and his call- 
ing, if you have prepared yourself and are known 
to give the best that is in you. the cheap man will 
go to the wall and your merit will receive its re- 
ward. If by chance any of you have not seen 
Dr. McCormick's paper on this question of fees 
and collections, let him by all means find the 
proper A. M. A. Journal and read it. It is a 
classic worth any man's time and attention. In 
concluding this subject, let me endorse what he 
says about the cheap man, the price-cutter. 
Whatever his charge may be, he is usually get- 
ting full value for his services. Realizing his 
lack of education or ability or temperament, or 
whatever it is that puts him below his profes- 
sional competitor, he cuts his fees in order to live. 
It is not our place to meet his competition, but to 
pity him. to extend to him the helping hand, to 
endeavor to elevate him to our standard, and 
never to lower ourselves to his. 

I have only a few words to say on the subject 
of professional confidences. So sacred is the re- 
lation between the physician and patient regarded 
that the courts will not compel a physician, while 
on the witness stand and under oath, to tell the 
truth, and not only the truth, but the whole truth. 
to reveal what is imparted to him in confidence 
by his patient. 



If in this exalted function of doing justice be- 
tween man and man the courts will not compel 
the recital of some important piece of evidence, 
how carefully should we regard our professional 
relation, and see to it that neither in strict confi- 
dence or in idle gossip do we betray the secrets 
that suffering man has confided in us. 

It may be somewhat out of place in a paper 
dealing with "The Ethics of the General Prac- 
titioner" to speak of the tendency, or perhaps 
better, the half-formed determination of the ma- 
jority of every class to be specialists. I must 
confine myself to the predilection of the average 
medical student for surgery. It was so in my 
day, and I suppose it is so now, that almost 75 
per cent, of the graduating classes are thoroughly 
satisfied that the end and aim of medicine is sur- 
gery ; that practice and the less spectacular 
branches are parts of the profession essential to 
it as a whole, and fitted for those who intend to 
lead the plodding life, but too slow and too pro- 
saic for the man bursting with the knowledge of 
his own brilliancy and his own special fitness. 
There is no question but that this tendency has 
done much to lower the average fitness of many 
classes. Men become listless and careless, 
neglecting everything but their hobby, and while 
the surgical amphitheatre is crowded, the medical 
clinics will be shunned, even dsserted were it not 
that the sections are such that the absentees can 
be spotted and warned. There is no question 
also but that indifference to everything but sur- 
gery is responsible for many of the failures be- 
fore the State Examining Boards. We must 
have surgeons, and they must begin their train- 
ing in medical schools, and it is not my purpose 
to discourage earnest work and honest effort to 
this end. I wish, however, to say that every 
ethical specialist needs a thorough grounding in 
the general branches of medicine, and he should 
not in his student days neglect the other essen- 
tials to a well-rounded man. Most heartily do I 
wish to condemn the careless, happy-go-lucky 
manner in which so many men totally unpre- 
pared and totally unsuited by temperament for 
this branch "rush in where angels fear to tread." 
I wish especially to draw your attention to the 
fact that there is a vast difference between the 
operator and the surgeon. Almost any young 
man with a disregard of the sight of blood, with 
nerves unaffected by human suffering and a heart 
unti inched by a knowledge of his power to do 
harm, can in six months' practice on the cadaver 



THE HOSPITAL BULLETIN 



29 



fearn to cut, to sew and to ligate with neatness 
and despatch. Indeed, there may be many before 
me of the student body whose young and nimble 
fingers could teach dexterity to the best surgeons 
of the city. Very many with no pretense to this 
dexterity, and no equipment but a superabun- 
dance of assurance, graduate as surgeons and 
assume and aspire to a position of prominence 
that it has taken the true surgeon years of the 
hardest, closest, most untiring study, observation 
and work to reach. We are told as an excuse for 
this remarkable evolution from the student to the 
surgeon that the young man of today is taught 
so much more than the old men were; that the 
very manner of teaching, the equipment of the 
schools and the superior requirements for matric- 
ulation cannot but turn out better posted and 
more competent men. There is much truth in 
this. There is much truth also in the fact that 
while more is taught, more, infinitely more, is 
demanded of the student, and the knowledge that 
would have secured him a diploma fifty years ago 
will now scarcely carry him through his fresh- 
man year. 

We also hear that "I want to be a surgeon, 
because surgery accomplished positive results." 
This is very true also, and it is evident that if you 
amputate a leg your patient will be minus a mem- 
ber. Don't lose sight of another fact, however, 
that if without being competent to meet any un- 
forseen emergency that may arise, you lightly 
open the abdominal cavity, you will have a posi- 
tive result in the shape of your own little private 
graveyard. The newly graduated surgeon is not 
as dangerous as the man who left medical school 
years ago, before the students received one-third 
of the surgical training that they do now. Many 
of these men have not taken a post-graduate 
course, have never been associated with a hos- 
pital, nor have they had even an opportunity for 
moderate surgical observation ; and yet they are 
attempting to do the work that only a skilled 
specialist should undertake. I am not speaking 
of emergency surgery for which any man should 
try to prepare himself, and be brave enough to 
undertake when human life is at stake. I am re- 
ferring to operations of election when the services 
of a competent man can be secured. The point 
is just this, gentlemen, that medicine as a science 
is the result of evolution and not the creation of 
some brilliant brain ; that what has been done in 
it has been accomplished not so much by inspira- 



tion as by close plodding work, exhaustive ex- 
periment and continual observation ; that surgery 
as one of its branches cannot be mastered in the 
four years of student life, but that to be surgeons 
you must be workers and observers. It will not 
do to settle the matter by saying that a man must 
make a start. This truth is too self-evident to 
be smart, nor is it entirely convincing. An 
answer equally true will be that you will not 
allow the embryo surgeon to start on you, and 
before you put yourself or your wife or your 
mother in his hands you will demand that he pos- 
sess some other qualification for his specialty 
besides his conceit, his gall and his need of the 
fee. There may be some exceptions where the 
man is born and not made, but I beg to assure 
you that the surgeon rarely springs full-fledged 
and fully fitted from the brain of Minerva. 

Our profession is nothing if not altruistic. It 
demands daily and hourly more of self-sacrifice, 
more of self-devotion, than any secular calling. 
Indeed, the comparison is often drawn between 
the nobility and necessity of the duties which we 
perform and those of him who by divine inspira- 
tion and laying on of hands has been called to 
succor the diseased soul. It is not my place nor 
is it my purpose to enter into a discussion of this 
point, and I mention it only to show that we are 
marked men in every community ; that we are 
placed on a higher plane and that more is ex- 
pected of us than of our brethren of the other 
liberal professions. This, indeed, is right, for no 
man, the priest possibly excepted, enters into 
such intimate relations with his people. He is 
ever present with them to share their sorrows 
and their joys, and in his position of family 
friend and family confessor it is his place to 
bind and salve wounds more deadly than those 
made by the hand of man. It is a popular im- 
pression that this close relationship between the 
physician and his people is one evolved by the 
brain of the novelist or one possessed by that 
most beloved, but now extinct, old family physi- 
cian. Let us get this impression from our minds 
and let us realize that our duties, our responsi- 
bilities and our relationship to those we serve are 
just the same, are just as close, and are just as 
engrossing as they were when that dear old patri- 
arch of the profession made his rounds, scolding 
some, chiding others and advising all to better, 
purer and nobler lives. Changed as our relation- 
ship to the community may be in some respects 



30 



THE HOSPITAL BULLETIN 



by the translation of many of the brightest and 
best of our cult into the ranks of the specialist, 
it is still and always will be the general practi- 
tioner who is looked up to as "the physician," 
and by his work in professional and private life 
our profession will be judged. 

In the beginning of my paper I stated I could 
do little more than rehearse to you some of the 
old axioms and maxims that have been handed 
down to us for generations. I am aware that I 
have taught you nothing new tonight, and that I 
have not tapped that fountain of inspiration from 
which genius gushes in poetic or oratorical 
streams. I trust I may have convinced you that 
it is not amiss for us at times to hold close com- 
munion with our souls, and to take stock of our 
moral and professional assets. The further I 
have advanced the more fully I have realized 
how impossible it is to evolve new ideas or elab- 
orate new creeds to supersede those by which the 
fathers lived and died and earned honor for 
themselves and our profession. 

So we face today, gentlemen, just about the 
same propositions that have always been ours to 
meet, and what was ethical one hundred years 
ago is ethical now. 

The science of human duty simply demands 
that you be honest to yourselves, honest to those 
you serve : that you may look every man squarely 
in the face and not as if you feared he had heard 
something you had said behind his back. May 
I quote to you the words of the Earl of St. Vin- 
cent to the immortal Xelson : "It is given to us 
all to deserve success ; mortals cannot com- 
mand it." 



THE STUDY OF RECTAL SURGERY IN 
NEW YORK CITY. 

By J. Dawson Reeder, M. D., 

Lecturer on Osteology, University of Maryland, 

Baltimore, Md. 

Having decided to take a course in Rectal Sur- 
gery, I arrived in New York ami matriculated 
at the New York Polyclinic Hospital on October 
ist for a course of instructions under Prof. 
James P. Tuttle, and desire to herewith describe 
briefly my reception : 

Professor Tuttle is a finished surgeon of the 
old school of gentlemen, a master of his art, and, 
under all conditions and circumstances, adheres 
strictly to the ethics of the profession. I was 



not only most cordially received by him socially, 
but was most fortunate in being honored by re- 
questing me to assist him, or be present, on oper- 
ations upon his private patients at an uptown hos- 
pital. This unexpected and friendly honor gave 
me an opportunity to observe closely the work of 
this great surgeon in detail, and I had the pleas- 
ure of witnessing every case under his care dur- 
ing my three months' visit. As to his collossal 
work on cancer of the rectum and sigmoid, his 
results are too well known for me to dwell upon 
at this time, and he has an enviable record which 
makes him the authority of this distressing mal- 
ady which is so prevalent in the cases referred to 
the Rectal surgeon, and have so long been un- 
recognized by the general profession. I had the 
pleasure of witnessing him extirpate the rectum 
by his bone-flap and perineal route, and in some 
of these cases was honored by being his assistant. 
As to the method and technique in each of the 
above mentioned. I will endeavor to give later. 
Another very important point gained by associa- 
tion with this surgeon was, that my own theory 
as to the merits of the Whitehead operation were 
simply an endorsement of his teachings, namelv, 
that this particular operation, while classical, was 
only justifiable in selected cases of hemorrhoids, 
while the Clamp and Cautery or the Ligature 
method had no restrictions as to variety or loca- 
tion of the pile mass. 

Another important subject was the question of 
treatment of Tubercular fistula. For a number 
of years Dr. Tuttle said he was most discouraged 
in his results and had almost abandoned any at- 
tempt to cure this class of infections, but of late 
he had obtained most excellent results by intro- 
ducing his soft flexible probe and following this 
tract with a grooved director; opening this 
throughout its entire extent, and then completely 
cauterizing at dull red heat with the actual cau- 
tery. This is then packed with iodoform gauze, 
and since using the cautery, his results have been 
decidedly better. Under the direction of his as- 
sistant. Dr. J. M. Lynch, a class of three was 
formed, with regular work and instructions in 
the dispensary of St. Bartholomew's Clinic, 
where we were given cases to diagnose and treat. 
This course consisted in introduction of procto- 
scope and sigmoidscope diagnosis of ulcerations 
specific and benign, and local treatment through 
this instrument. To the inexperienced the re- 
sults and probabilities gained through the use of 



THE HOSPITAL BULLETIN 



31 



this pneumatic instrument of Tuttle's, which is 
a modification of the Laws proctoscope, are sur- 
prising. By the electric illumination with which 
it is equipped one is able to introduce the instru- 
ment with absolute safety to the patient for a 
distance of 10 to 14 inches, exploring the entire 
circumference from the anus up through the sig- 
moid. 

My next course of instructions was under the 
direction of Prof. Samuel Gant at the New York 
Post-Graduate Medical School. Dr. Gant like- 
wise was most cordial in his reception, and on 
several occasions honored me by entertainments, 
including letters of membership to his club, and 
at his home with his family. Dr. Gant, also a 
master of his art, has made a reputation of re- 
nown, and is a most successful operator. While 
of an entirely different character from that of 
Dr. Tuttle he is equally attractive. Dr. Gant 
argues that the majority of cases of cancer when 
seen by the specialist are too far advanced to offer 
any hope by radical operation, and generally lim- 
its his attempts at relief to a colostomy. As to 
the merits of this procedure, I am not sufficiently 
versed to offer criticism further than to say that 
the results of Dr. Tuttle are certainly encourag- 
ing to the surgeon who will undertake this ordeal 
of extirpation in hopes of eradicating the disease, 
while Dr. Gant's operation of colostomy, of 
course, is only palliative, he making no claims of 
a cure, except when the growth is seen very 
early and is freely movable ; then he will extir- 
pate. 

As to the operation for hemorrhoids, Dr. Gant 
uses ligature and sterile water anesthesia in near- 
ly every case, and the patient is thereby cured 
without the administration of a general anes- 
thetic. The difference in the time of recovery is 
a question to be always considered, in my own 
judgment, and is as follows: Dr. Tuttle uses 
the clamp and cautery almost universally, and the 
patient is discharged within the period of one 
week, while the ligature method requires local 
treatments to the ulcerations produced by the 
sluffing of the linen threads, and takes from 10 
clays to three weeks. 

Constipation and Obstipation are treated sur- 
gically by both of these gentlemen by the opera- 
tion of Sigmoidopexy or Colopexy, which con- 
sists in anchoring the gut to the abdominal pa- 
rietes after having first stripped back the perito- 
neum over the area covered by their sutures. 



Chronic diarrheas and Amebic Dysentery are 
likewise treated by Appendicostomy and Caecos- 
tomy. The difference in this operation being that 
the former consists in delivering the appendix 
upon the abdomen and fixing the same with cat- 
gut sutures until the peritoneal cavity is walled 
off by adhesions, and then amputating later, so 
that the stump may be dilated to permit of regu- 
lar colonic irrigations. 

Dr. Gant performs a similar operation, to 
which he has applied the name of Caecostomy, 
and having devised an ingenious director con- 
sisting of one metal rod within a tube of slightly 
larger calibre, he is able to pass the obturator 
through the ileo-caecal valve, and then, by with- 
drawing the rod or obturator, is able to pass a 
rubber catheter into the small intestine. The 
metal tube is then withdrawn and a shorter cath- 
eter is placed parallel with the long one, which 
necessarily is in the caput, and after placing clips 
upon each tube to prevent leakage, he is able to 
flush out both large and small bowel at desired 
intervals. 

As to the irrigations through these newly- 
made openings, it is a matter of choice with dif- 
ferent operators, those in greatest favor, I think, 
being Ice Water, Aq. Ext Krameria and Quinine 
Solution. 

A very interesting case brought before us by 
Dr. Tuttle was one of Specific Stricture of the 
Rectum, and the treatment anticipated is as fol- 
lows: He performed a Maydl-Reclus Colostomy 
in the transverse colon, in order first to treat the 
ulcerations and infected area locally, and, sec- 
ondly, so that he would have sufficient gut above 
the stricture to do a Perineal extirpation later 
and bring down new healthy intestine from the 
upper Sigmoid for a new permanent anus ; then 
later he would close the artificial anus in the 
transverse colon, and his patient should have a 
perfect result. The period required for these 
three operations would cover a period of not less 
than nine months: and if after this there is not 
perfect Sphincteric action, Dr. Tuttle does a 
plastic operation to repair his sphincter. 

Before continuing with a brief description of 
the technique of Extirpation as above referred 
to, I wish to herewith express my sincere grati- 
tude and appreciation of the many honors and 
courtesies extended to me by these gentlemen, 
and am quite sure that the same was not all per- 
sonal, but honor to the University of Maryland's 



3:2 



THE HOSPITAL BULLETIN 



Faculty of Physic, who have aided so materially 
this younger specialty by such men as Hem- 
meter, Pennington and Earle, who are constantly 
quoted by all intestinal and rectal surgeons. 

EXTIRPATION OF RECTUM. 

The operation of removing the rectum is now 
almost two centuries old. Faget performed it in 
1739, but Listfrane first successfully extirpated 
the rectum for cancer in 1826. The results of 
the operation in nine cases were embodied in a 
thesis by one of his students (Penault, Thesis, 
Paris, 1829), and in 1833 the great surgeon him- 
self gave to the world a complete account of his 
operation and method, thus establishing the pro- 
cedure as a surgical measure. The results in 
these cases were not calculated to create any 
great enthusiasm, for the mortality was high 
owing to the lack of aseptic technique. The 
methods described in older books give us five 
varieties of operation for extirpation — the pe- 
rineal, the sacral, the vaginal, the abdominal and 
the combined. In this paper I shall only en- 
deavor to describe briefly the two methods used 
by Dr. Tuttle. Before describing these methods 
in detail it may be well to consider the prepara- 
tion of the patient, which is practically the same 
in each. In order to obtain the best results, it is 
necessary to increase the patient's strength as 
far as possible by forced feeding for a time, to 
empty the intestinal tract of all hard and putri ty- 
ing faecal masses, to establish as far as we may 
intestinal antisepsis and to check, in a measure, 
the purulent secretion from the growth. It re- 
quires from 7 to 10 days, or longer, to properly 
prepare a patient for this operation. The diet 
best calculated to obtain a proper condition of the 
intestinal tract is generally conceded to be a ni- 
trogenous one. The absolute milk diet is not so 
satisfactory as a mixed diet composed of meat, 
strong broth, milk and a small quantity of bread 
and refined cereals. The patient should be fed 
at frequent intervals, and as much as he can di- 
gest. Along with this forced feeding one should 
administer daily a saline laxative which will pro- 
duce two or three thin movements, and to disin- 
fect the intestinal canal one should give through 
the stomach three or four times a day sulpho- 
carbolate of zinc, grs. iiss., in form of an en- 
teric pill. On the day previous to the operation 
the perinaeum, sacral region and pubis should be 
shaved, dressed with a soap poultice for two 
hours, then washed and dressed with bichloride 



dressing, which should be retained until patient is 
anesthetized. Notwithstanding- all of these prep- 
arations, it is impossible to obtain absolute asep- 
sis of the affected area, and so many fatalities 
occur from infection that it is deemed wise by 
many surgeons to make an artificial inguinal 
anus as a preliminary procedure in all extirpa- 
tions of the rectum. 

PERINEAL METHOD. 

Under this method may be included certain 
operations for small epitheliomas low down in 
the rectum done through the anus. The patient 
having been properly prepared, the sphincter is 
thoroughly dilated ; a circular incision through 
the entire wall of the gut is made, and the seg- 
ment is caught with traction forceps and dragged 
by an assistant while the operator frees, by scis- 
sors and blunt dissection, to a point at least one- 
half inch above the cancer. The free end of the 
gut is then tied with strong tape, as the tempta- 
tion is very great to put your finger in the bowel 
as a guide, and thereby invite infection. A deep 
dorsal incision is then made, going down to the 
right of the coccyx through the post-rectal tissue. 
The hand is then placed in the sacral fossa and 
the structures lifted out into the pelvis, after 
which this space is thoroughly packed with gauze 
to control the bleeding and hold the structures 
out of the fossa. • The edges of the wound, in- 
cluding each half of the sphincter which 
has been cut posteriorly, are held by flat retract- 
ors, while the operator proceeds to dissect the 
anterior portion of the rectum loose from its at- 
tachments. A sound should be held in the 
urethra in men and an assistant's finger in the 
vagina in women to prevent wounding these or- 
gans. After the gut has been dissected out well 
above the tumor, it is caught by clamps and cut 
off below these. Bleeding is controlled by liga- 
tures and equal parts of hot water and alcohol. 
This newly-exposed gut is then sterilized by pure 
carbolic acid and alcohol, or may be seared with 
cautery. Sometimes the peritoneum can be 
stripped off from the rectum and its cavity need 
not be opened ; it is better, however, to open the 
cavity at once when the growth extends above 
this point. The peritoneum is incised, cut loose 
from its attachments close to the rectum, back to 
the mesorectum. which should be cut close to the 
sacrum, in order to avoid the inferior mesenteric 
artery. When the gut has been loosened suffi- 
ficientlv above the tumor, it mav be still fastened 



THE HOSPITAL BULLETIN 



3$ 



by two lateral peritoneal reflections, which are 
the lateral rectal ligaments, and should be cut at 
once. The gut is then brought down and sutured 
to the anus, and the operator should proceed to 
close the peritoneum and restore the planes of 
the pelvic floor down to the levator ani by fine 
catgut sutures. After this has been accom- 
plished, the anus, which is now well outside the 
operative field, should be reopened, the gauze 
removed, and the gut flushed with a solution of 
bichloride or peroxide of hydrogen. Ouenu ad- 
vises that in amputating each layer should be cut 
separately, in order to avoid hemorrhage, but 
there appears to be no advantage in this ; in fact, 
we are more likely to meet with deficient blood 
supply, causing subsequent sloughing of the gut, 
than with hemorrhage. The posterior and ante- 
rioT portions of the perineal wound are packed 
with gauze and left open to assure drainage, and 
the parts are covered with aseptic pads, held in 
position by a well-fitting "T" bandage. A large 
drainage tube is passed well up into the rectum, 
its lower end extending outside of the dressings, 
in order to convey the discharges and gases be- 
yond the operative wound. 

tuttle's bone flap operation. 

"The Kraske Operation" is applied to various 
methods in which access to the rectum is ob- 
tained by removing the coccyx or cutting off 
certain portions of the lower end of the sacrum. 
They are all modifications of Kraske's original 
method, with which we are all familiar. Dr. 
Tuttle has modified this plan, as it furnishes a 
rapid and adequate approach to the rectum ; it 
facilitates the control of hemorrhage and restores 
the bony floor of pelvis and attachment of the 
anal muscles, and involves injury of the sacral 
nerves and lateral sacral arteries on one side 
only. The technique which he employs is as fol- 
lows : 

The patient is previously prepared as hereto- 
fore described, and an artificial anus established 
or not, as the conditions indicate ; before the final 
scrubbing the sphincter should be dilated and the 
rectum irrigated with bichloride 1-2000 or hydro- 
gen peroxide. It should then be packed with ab- 
sorbent gauze, so that the finger cannot be intro- 
duced. The patient is then placed in the prone 
position on the left side, with the hips elevated 
on a hard pillow or sandbag ; an oblique incision 
is made from the level of the third foramen on 
right side of sacrum down to the tip of the coc- 



cyx, and extending half-way between this point 
and the posterior margin of the anus. 

This incision should be made boldly with one 
stroke through the skin, muscles and ligaments 
into the cellular tissue posterior to the rectum ; 
the rectum is then rapidly separated by the fin- 
gers from the sacrum, and the space thus formed 
and the wound should be firmly packed with 
sterile gauze. A transverse incision down to the 
bone is then made at a level of the 4th sacral 
foramen, the bone is rapidly chiseled off in this 
line, and the triangular flap is pulled down to the 
left side and held by retractor. At this point it 
is usually necessary to catch and tie the right 
lateral and middle sacral arteries. Frequently 
these are the only vessels that need to be tied 
during the entire operation, although if one cuts 
too far away from the sacrum, the right sciatic 
may be severed. The first step in the actual ex- 
tirpation of the rectum consists in isolating the 
organ below the level of the resected sacrum, so 
that a ligature can be thrown around it, or a long 
clamp applied to control any bleeding from its 
walls. If the neoplasm extends above this level 
and it is necessary to open the peritoneal cavity 
to extirpate it, one should do this at once, as it 
will be found much easier to dissect the rectum 
out by following the course of the peritoneal 
folds. By opening the peritoneum and incising 
its lateral folds close to the rectum, the danger 
of wounding the ureters is greatly decreased and 
the gut is much more easily dragged down. 

When the posterior peritoneal folds or meso- 
rectum is reached, the incision should be carried 
as far away from the rectum, or, rather, as close 
to the sacrum, as possible in order to avoid 
wounding the superior hemorrhoids artery, and 
to remove all the sacral glands. The gut should 
be loosened and dragged down until its healthy 
portion easily reaches the anus or healthy seg- 
ment below the growth. A strong clamp should 
then be placed upon the intestine about one inch 
above the neoplasm, but should never be placed 
in the area involved by it ; for in so doing the 
friable walls may rupture and the contents of 
the intestine be poured out into the wound. As 
soon as the gut has been sufficiently liberated 
and dragged down, the peritoneal cavity should 
be cleansed by wiping with dry sterilized gauze 
and closed by sutures which attach the mem- 
brane to the gut. By this procedure the entire 
intraperitoneal part of the operation is completed 



34 



THE HOSPITAL BULLETIN 



and this cavity closed before the intestine is in- 
cised. After this is done the gut should be cut 
across between two clamps or ligatures above the 
tumor, the ends being cauterized with carbolic 
acid and covered with rubber protective tissue. 
The lower segment containing the neoplasm may 
then be dissected from above downward in an 
almost bloodless manner until the lowest portion 
is reached. It is much more easily removed in 
this direction than from below upward, and there 
is less danger of wounding the other pelvic or- 
gans. If the neoplasm extends within one inch 
of the anus, it will be necessary to remove the 
entire lower portion of the rectum. If, how- 
ever, more than one inch of perfectly healthy 
tissue remains below, this should always be pre- 
served. Having removed the neoplasm, if one 
inch or more of healthy gut remains above anus, 
one should unite the proximal and distal ends 
either by Murphy button or end-to-end suture. 

All oozing is checked by hot compresses, and 
the concavity of the sacrum is packed with a 
large mass of sterilized gauze, the end of which 
protrudes from the lower angle of the wound. 
This serves to check the oozing, and also fur- 
nishes a support to the bone-flap after it has been 
restored to position. Finally the flap is fastened 
in its original position by silk-worm gut sutures, 
which pass deeply through the skin and perios- 
terum on each side of the transvere incision. 
Suturing the bone itself is not necessary. The 
lateral portion of the wound is closed by similar 
sutures down to the level of the sacro-coccygeal 
articulation : below this it is left open for drain- 
age (Tuttle, Diseases of Rectum, Page 829 — 
I903)- 



REPORT OF A CASE OF GANGRENOUS 

APPENDICITIS, FROM THE SERVICE 

OF PROF. R. WINSLOW. 

By C. C. Smixk, '09, 
Senior Medical Student. 

In selecting a case I have not taken one that is 
a surgical curiosity, or at all an unusual one, but 
I have taken this because it is just in these cases 
that a doubt sometimes exists as to the treat- 
ment when diagnosed, and often the condition of 
the appendix and surrounding peritoneum is in 
doubt, even if a diagnosis of trouble originating 
in the appendix is made. 

History of Case — Patient, a boy, L. \Y., age 



9 years, schoolboy; admitted December 26, 1908, 
with a diagnosis of appendicitis. 

Family History — Parents well ; one brother 
died in infancy, cause unknown ; two brothers 
living and well; only history of any family dis- 
ease is tuberculosis in one uncle; no rheumatism, 
syphilis, gout, haemophalia or other disease 
bearing on the case. 

Past History — Measles at 5 years, with une- 
ventful recovery; whooping-cough at 6, no com- 
plications ; badly burned two years ago ; has had 
"indigestion" (?) since he was 3 years old; pain 
but no tenderness during these attacks ; treated 
by different physicians and got better for a time ; 
no history of scarlet fever, influenza, pneumonia, 
typhoid or other disease of childhood. 

Habits — A normal child. 

Present Illness — On 20th of December, 1908, 
patient came home from church complaining of 
pains in the right side. This was Sunday. Next 
day he complained of severe pain all over abdo- 
men, but on Tuesday these became localized in 
the right lower quadrant of the abdomen. Had 
some fever. Bowels constipated. No nausea or 
vomiting. There was a localized tenderness in 
the right lower quadrant from the start. Pains 
got better on Friday, but temperature and pulse 
still stayed up, and patient came into hospital on 
Saturday, December 26. The unusual feature 
was that there was no nausea or vomiting. It is 
also to be noted that the pain subsided suddenly 
on the 24th. The child entered hospital on the 
26th. and on entrance the whole right side was 
rigid, while the left side was comparatively soft. 
A lump could be felt in the appendical region, the 
centre of which was above McBurney's point. 
Temperature was 99 and pulse 78. The leuco- 
cyte count, however, was 30.200 ; urine negative. 

Child was put to bed ; an ice cap placed on the 
abdomen. Liquid diet. The next day, December 
27th, leucocytes stood at 35,200. Temperature 
unchanged, but the pulse had risen to no beats. 
A hypodermic of morphine and atrophine was 
given, and patient taken to the operating room, 
anesthetized, and abdomen cleaned for an asep- 
tic (if possible) operation. 

Prof. Winslow made an incision in the abdom- 
inal wall, well out toward the crest of the ilium, 
using the gridiron incision. The caecum was 
found and pulled over toward the middle line, 
and in looking for the appendix, which was sup- 
posed to be behind the caecum, a great quantity 



THE HOSPITAL BULLETIN 



35 



of pus was found. This nasty smelling, grayish 
pus welled up into the wound and was sponged 
away. Several pieces of mucous membrane and 
presumably the tip of the appendix were found in 
the pus. Also several faecal secretions. The pus 
was sponged away and carefully a search was 
made for the appendix, or rather what remained 
of it. It was found tied down by adhesions and 
dissected loose. It broke away in pieces, and it 
was unnecessary to ligate any of the arteries of 
the meso appendix. The stump of the appendix 
close to the caecum was crushed, cauterized and 
ligated. No attempt was made to invert it, as 
the tissues would not stand it. The pus cavity 
was found to extend up behind the caecum and 
over toward the median line for some distance. 
The puncture, which I will refer to later, was 
then made in the right lumbar region, and two 
cigarette drains were introduced extending clear 
back into the bottom of the abscess cavity. Then 
a gauze drain was introduced into the anterior 
wound, and this sutured up. The wound was 
then dressed and the patient taken to the ward. 
Recoverv from anesthetic without ill effects. 

The next morning the patient was unable to 
pass his water, and had to be catheterized. Aside 
from this no ill effects were seen, and his tem- 
perature and pulse remained practically at the 
same place. At the end of 48 hours the drains 
and dressings were changed and the patient was 
doing well and the wound draining profusely. 
At no time was the bed elevated and at no time 
was a stimulant administered, with the exception 
of a hot normal salt enema on the day following 
the operation. Several times during his stay a 
dose of castor oil was given, but no other medica- 
tion was necessary. As the dressings were reap- 
plied and drains introduced daily the wounds 
were found to be granulating' up, and gradually 
these closed, first the one in the lumbar region 
and then the one in the abdomen. By the tenth 
day a normal temperature was present, and he 
sat up on the twelfth. 

The child went on to an uneventful recovery, 
and went home on January 21st fully cured. 

This was undoubtedly one of those cases of 
gangrenous appendicitis where, owing either to 
the intensity of the infection or to a thrombosis 
of the vessels supplying the appendix, the vitality 
of the tissues is lost and gangrene results. Now, 
"even in this, the gravest form of appendicitis, 
the general peritoneal cavity is often protected 
against infection by walling off the pus, and the 



appendix, detached in the form of a slough, is 
often found on opening the localized abscess." 
But "in other cases there is from the beginning 
the symptoms of peritoneal sepsis and perito- 
nitis." 

Now, it seems to me that a great deal depends 
on the kind of infection — or, rather, the kind of 
organism infecting — and often the difference be- 
tween a localized abscess and a general peritonitis 
is really the difference between a colon and a 
streptococcus infection. Again, should a general 
peritonitis develop, I have noticed from a num- 
ber of cases in the wards that the prognosis prac- 
tically depends on the organism, although we all 
know that a general peritonitis is a mighty grave 
condition, no matter what it is due to. 

Another point in favor of the child was the 
fact that the gangrenous process seemed to start 
in the tip of the appendix, and it seems that when 
it starts there, there is greater likelihood of lo- 
calization, and when it starts in the base a 
greater likelihood of general peritonitis. 

I said that there was often doubt as to the con- 
dition in the abdomen in these cases. Now, there 
can be no doubt that the two main points in the 
diagnosis of a localized abscess are tumor and 
an aggravation of the symptoms present. But 
this case exemplified the fact that there may be 
cases where there is no aggravation of symp- 
toms, and in a great many cases it may be im- 
possible to feel the tumor until it has become 
very large, owing to its situation, viz., post cae- 
cal. Even in this case, from which a great quan- 
tity of pus was evacuated, there was no absolute 
certainty of finding pus on opening the abdomen, 
although it was suspected strongly. 

I have seen a patient walk into the hospital on 
Sunday with a temperature of 100 and a pulse of 
99, and when the abdomen was opened on Mon- 
day morning a most virulent form of general 
streptococcus peritonitis was found, from which 
the patient died the next day. It is said that it is 
much better to depend on the pulse and its varia- 
tions than on the temperature. 

I would like to call attention to several points 
in the treatment of this case also. 

First, the place of incision was, as I said, well 
up towards the iliac crest, and not in the time- 
honored McBurney point. The wisdom of this is 
self-evident. 

Second, the care used in not breaking up the 
wall of the abscess formed by the peritoneum. 



3ti 



THE HOSPITAL BULLETIN 



Also, the fact that the appendix was carefully 
dissected up and tied off and allowed to heal by 
itself, obviating, as much as possible, the danger 
of a faecal fistula. The older books advised 
evacuating the abscess and leaving the appendix 
to slough off, and, while I have seen seven cases 
where this method was used and not a single 
faecal fistula, yet it seems to me the more rational 
treatment to remove the offender, as I have also 
assisted in three operations where the appendix 
was removed at the second operation. That is, 
an operation supposedly an appendectomy was 
done, and later, at a subsequent period, the dis- 
eased appendix was found still causing the same 
old trouble. 

Again, the use of the lumbar puncture, so as 
to drain the abscess cavity from its very bottom. 
I wonder this is not done oftener, as it appeals 
to me as being a most sensible thing. 

Then the abscess cavity was sponged out with 
gauze, and not washed out with the antiseptic 
fluid that books advise, thus spreading bacteria 
all over the peritoneal cavity, and really doing 
no good. Nature was allowed to throw off such 
things as she deemed necessary, an avenue of es- 
cape having been provided. 

And, lastly, the omentum was found and 
brought down, covering in the cavity as much as 
possible, and thus aiding in the walling off pro- 
cess. 



DIRECT LARYNGOSCOPY. 

By Richakd H. Johnstox, M. D. 

Read Before the Baltimore City Medical Society, 

Section on Medicine and Surgery, 

February, 1909. 

Direct laryngoscopy, as the name implies, is the 
inspection of the larynx through a hollow tube 
without the use of a mirror. The examination is 
made with the patient in the sitting position, 
under local anesthesia, or in the prone position, 
tinder general anesthesia. To examine the larynx 
in the sitting position it is practically always nec- 
essary to give a hypodermic injection of morphia 
and atropia a half hour beforehand, to relax the 
muscles and to prevent excessive secretion. The 
patient is seated upon a low stool with the head 
extended and supported by an assistant. With 
curved forceps 20% cocaine or 25% alypin solu- 
tion is quickly passed into the throat, anesthetiz- 
ing pharynx, tongue and epiglottis. Jackson's 
slide speculum is then introduced and the base of 
the tongue, with the epiglottis, gently pulled for- 
ward. At this point it is usually necessary to use 
more cocaine directly in the larynx, which is intro- 
duced by means of special cotton carriers. In a few 
minutes anesthetization is complete, and the ex- 
amination can be made at leisure. It will be 
found easier to inspect the different parts of the 
larynx if the head is held about halfway between 
the erect position and complete extension. In 



some patients with short, thick necks and large 
middle incisor teeth the slide will have to be re- 
moved from the speculum to enable one to see 
well. The examination in the prone position 
under general anesthesia is made with the 
patient's head over the end of the table supported 
by an assistant. The speculum is introduced and 
the base of the tongue and the epiglottis pulled 
upward forcibly. In this position direct laryn- 
goscopy, even in children, is unsatisfactory, and 
operative procedures are well-nigh impossible on 
account of the muscular rigidity. The force re- 
quired to lift the tissues is so great and the posi- 
tion of the arm is so cramped that it is difficult 
to get a clear view of the field. The difficulty has- 
impressed all who have worked in this particular 
line. It remained for Dr. H. P. Mosher, of Bos- 
ton, to discover a method of direct laryngoscopy" 
which makes it as simple under ether anesthesia 
as in the sitting position. In April, 1908, he de- 
scribed in the Boston Medical and Surgical Jour- 
nal the "left lateral position" for examining the 
larynx and the upper end of the esophagus. He 
designed certain instruments which I believe are 
too cumbersome to meet with popular favor. In 
Mosher's position the patient lies on the table 
with the head turned toward the left until the 
cheek almost rests on the table; the chin is flexed 
on the chest. In our work at the Presbyterian 
Hospital we have found a modified Mosher's po- 
sition and Jackson's child speculum the ideal com- 
bination for the examination in the prone patient. 
In children the procedure is carried out with or 
without anesthesia. Without anesthesia the head r 
hands and feet are held, the chin is flexed on the 
chest in a normal position by placing a pillow 
under the head, the speculum is introduced and 
the larynx inspected. In adults under anesthesia 
the same procedure is used, and will be found 
much simpler than the extended position. In 
adults, after the speculum is in position, if the 
anterior part of the larynx is not seen, gentle 
pressure on the thyroid cartilage will bring the 
anterior commissure into view. Operations can 
be done through the tube satisfactorily. With 
the different methods of direct laryngoscopy it is- 
possible to remove any growth from the larynx. 
919 N. Charles Street. 



ITEMS. 



The Board of Trustees of the Permanent En- 
dowment Fund of the University held its annual 
meeting on January 11. Judge Stockbridge was- 
re-elected president and Mr. J. Harry Tregoe sec- 
retary-treasurer, and, with Dr. Samuel C. Chew 
and Judge Sams, constitute the executive com- 
mittee for the year 1909. The funds and securi- 
ties in hand total the gross sum of $18,635.74. 



A special meeting of the Washington Branch 
of the General Alumni Association was held at 



THE HOSPITAL BULLETIN 



37 



the office of the president, Dr. Monte Griffith, 
March n, 1909, to consider the advisability of 
petitioning the Board of Regents to establish a 
Board of Alumni Counsellors, a paid president 
and a Board of Trustees, independent of the 
teaching faculties. Resolutions in favor of these 
measures were adopted. 



Dr. Louis W. Knight, class of 1866, of Balti- 
more, has presented to Loyola College a valuable 
collection of papal medals. 



Drs. H. O. and J. N. Reik have removed their 
offices to 506 Cathedral street. 

Drs. W. D. Scott and W. E. Wiegand attended 
the banquet of the Virginia Military Institute 
Alumni Association of Baltimore, held at the 
New Howard House, March 2, 1909. Dr. W. D. 
Scott responded to the toast "The Younger Gen- 
eration and the Splendid Work of the Virginia 
Military Institute Today." 



Major William F. Lewis, class of 1893, U. S. 
A. Medical Corps, has been relieved from duty at 
Fort Thomas and ordered to sail on June 5, 1909, 
for the Philippine Islands, via San Francisco, for 
duty. 



Dr. Hugh A. Maughlin, class of 1864, of 121 
North Broadway, an official in the United States 
Custom Service, who was assistant surgeon in 
the Sixth Maryland Regiment during the Civil 
War, is dangerously ill of pleurisy at his home. 
Dr. Maughlin is a member of Wilson Post, G. 
A. R. 



Dr. James A. Nydegger, class of 1892, past as- 
sistant surgeon, United States Public Health and 
Marine Hospital Service, has been promoted to 



the rank of surgeon. 



Dr. Eugene H. Mullan, class of 1903, assistant 
surgeon, United States Public Health and Marine 
Hospital Service, has been commissioned a past 
assistant surgeon, to rank as such from February 

2, 1909. 



Dr. Samuel T. Earle, Jr., of Baltimore, Aid , 
records the case of Mrs. F. H. D., who, the latter 
part of August, 1907, while eating ham, swal- 
lowed a plate with two false teeth. Ten days 
later she had a violent attack of pain in the abdo- 
men, followed by a chill and fever. There was 
no recurrence of this for one and a half months. 
Since then they have recurred from time to time. 
but not as severe, nor have they been attended 
with chill and fever. A diagram taken of the 
lower abdominal and pelvic regions showed the 
plate in the sigmoid flexure of the colon, on a 
level with the promontory of the sacrum. Exam- 
ination through the sigmoidoscope brought it into 
view at the point shown by the X-ray. There was 



considerable tenesmus, and the passage of a good 
deal of mucous, also a tendency to constipation. 
Under the influence of two hypodermics of mor- 
phine, gr. 1-4, hyoscine hydrobromate, gr. gr. 
L-100, and cactina, which produced satisfactory 
anesthesia, Dr. Earle was able to grasp the plate 
through the sigmoidoscope with a pair of long- 
alligator forceps, and withdraw it immediately 
behind the sigmoidoscope. 



At the Conference on Medical Legislation, held 
in Washington, D. C, January 18-20, 1909, reso- 
lutions were adopted providing for a committee 
composed of one member each from the medical 
departments of the Army and the Navy, one from 
the Public Health and Marine Hospital Service, 
one member from the District of Columbia and 
one member from the Council on Medical Legis- 
lation, to present to the medical profession the 
conditions under which the widow of Major 
James Carroll is now placed, and to devise such 
plans as might seem advisable for her relief. The 
following committee was appointed: Major M. 
W. Ireland, U. S. A. ; Surgeon W. H. Bell, U. S. 
N,; Dr. John F. Anderson, U. S. Public Health 
and Marine Hospital Service ; Dr. John D. 
Thomas, Washington, D. C, and Dr. A. S. Von 
Mansfelde, of Ashland, Nebraska. 

Mrs. Carroll has been granted a pension of 
$125 a month on which to support herself, seven 
young children and the aged mother of her hus- 
band. The house, which Major Carroll had 
partly paid for, is mortgaged for $5,000. Since 
the conference adjourned the medical officers of 
the Army have raised enough to pay the taxes on 
the house, one monthly note of $50 and the over- 
due interest on the first mortgage, amounting to 
$125. Believing that the members of the medical 
profession will wish to contribute toward a fund 
for the purpose of paying the balance due on the 
house, the committee requests contributions of 
any amount. They may be sent to Major M. W. 
Ireland, United States Army, Washington, D. C. 
The editors of The Bulletin sincerely hope our 
alumni will honor the memory of our most dis- 
tinguished alumnus by contributing liberally to 
this most worthy cause. 



At the last regular meeting of the University 
of Maryland Medical Association, held in the am- 
phitheatre of the University Hospital, Tuesday, 
March 16, 1909, the program was as follows: 
1, "The General Practitioner: His Relation to His 
Patients, to His Fellow Practitioners and to the 
Community in Which He Lives," Dr. Guy Steele, 
Cambridge, Md. ; 2, "Medical Ethics," Dr. Sam- 
uel C. Chew. Dr. A. M. Shipley, the president, 
was in the chair, and called the meeting to order 
promptly at 8.30 P. M. The attendance was 
large and appreciative, and listened to two re- 
markably able addresses. Those who had 
the privilege and pleasure of listening to the 
words of wisdom and advice both of Dr. Chew 



38 



THE HOSPITAL BULLETIN 



and Dr. Steele went away with a clearer concep- 
tion of their duties to their professional brethren 
and the public. 

Immediately after the adjournment of the 
Medical Association the Adjunct Facvdty, with 
its president. Dr. Joseph W. Holland, in the chair, 
held a very important meeting, the gist of which 
is as follows: Resolved by the Adjunct Faculty 
of the Medical Department of the University of 
Maryland that the Board of Regents be implored 
to effect such changes in the charter as to make 
possible the election of a president with a fixed 
salary, and with the duties usually associated 
with that office in standard universities, and a 
Board of Administrators independent of teaching 
faculties. The Adjunct Faculty also endorsed 
tentative plans looking towards the formation of 
an advisorv board of alumni counsellors. 



At the meeting of the Section on Opthalmology 
and Otology, Thursday, March n, 1909, at the 
Faculty Hall, the following of our alumni read 
papers: "Rodent Ulcer of the Cornea (Ulcus 
Rodens Mooren), with Exhibition of the Case," 
Dr. R. L. Randolph; "Purulent Otitis Media of 
Infancy and Childhood," Dr. H. O. Reik. 



At the meeting of the Section on Neurology 
and Psychiatry, Friday, March 12, 1909, the fol- 
lowing participated: "History and Forms of 
Chorea," Dr. N. M. Owensby; "Etiology of 
Chorea," Dr. H. D. McCarty; "Treatment of 
Chorea," Dr. W. S. Carswell. 



The Baltimore Star of March 27th, 1909, has 
this to say concerning Prof. Randolph Winslow: 
"Prof. Randolph Winslow, head of the Depart- 
ment of Surgery of the University of Maryland, 
is one of the best-known lecturers and demon- 
strators in the East. He is a close student, and 
has the faculty of impressing the young men of 
the University with the force of and practicability 
of his knowledge. Professor Winslow stands 
high in medical and surgical circles of the coun- 
try, and ranks with the best surgeons." Under 
the caption of the leading men of Maryland The 
Star also included a photograph of Professor 
Winslow. By honoring Dr. Winslow The Star 
also honors the University of Maryland, whose 
authorities feel a natural pride in the eminent po- 
sition held by its professors. 

Dr. Fitz Randolph Winslow, class of 1906, a 
former resident physician in the University Hos- 
pital, and a resident of Baltimore, has located at 
Hinton, Virginia. 



The Phi Sigma Kappa Fraternity had an at- 
home Saturday, March 27, 1909. 



About sixty members of the Theta Nu Ep- 
silon Fraternity, University of Maryland, at- 
tended a banquet at the Belvedere recently. It 
was served in the main hall, and the tables, which 



formed a semicircle, were beautifully decorated 
with trailing asparagus and cut flowers. During 
the meal a string orchestra rendered popular se- 
lections. Dr. Arthur M. Shipley, toastmaster, 
introduced Mr. Frederick W. Rankin, who made 
the address of welcome. Mr. Rankin was fol- 
lowed by Dr. C. H. Richards, who responded to 
the toast "Past and Present;" Dr. W. D. Scott 
had as his subject "The Fraternity Man;" Dr. 
R. Dorsey Coale, "The Undergraduate :" Dr. 
Randolph Winslow, "The Near Doctor;" Dr. 
John C. Hemmeter, "Our University," and Mr. 
C. B. Mathews, "The Ladies." The reception 
committee in charge of the arrangements was as. 
follows: Frederick W. Rankin, chairman; Ross 
S. McElwee ; John W. Robertson, John S. Man- 
digo, Arthur L. Fehsenfeld, J. F. Anderson. 



DEATHS. 



Dr. Joseph R. Owens, class of 1859, mayor of 
Hyattsville, Md., and treasurer of the Maryland 
Agricultural College, died at his home, in Hy- 
attsville, March 15, 1909, after a lingering illness 
of six months. Death came peacefully, and at 
the bedside were his wife, who was Miss Ger- 
trude E. Councilman, of Worthington Yalley,- 
Baltimore county, Md. ; his daughter, Mrs. Geo. 
B. Luckey, and his son, Charles C. Owens, of 
New York. Besides these he is survived by his 
mother, Mrs. Percilla Owens, 90 years of age ; a 
son, Mr. L. Owens, of New York, and a daugh- 
ter, Mrs. A. A. Turbeyne, of England. 

Dr. Owens was born in Baltimore, February 
20, 1839, and was 70 years old. His parents re- 
moved to West River when he was seven years 
of age. When he was ten years old he entered 
Newton Academy, Baltimore, and in 1859 was 
graduated from the Medical Department of the 
University of Maryland. Immediately after leav- 
ing the University he was appointed resident 
physician at the Baltimore City Almshouse, and 
served in this capacity to 1861, when he returned 
to Anne Arundel county and began farming on 
West River. In 1885 he removed to Hyattsville 
-uand accepted the position of clerk of the Claims 
Division of the Treasury Department, Washing- 
ton. He held this office until 1890, when he was- 
named as treasurer of the Maryland Agricultural 
College, which position he filled until death. For 
several years Dr. Owens was collector of taxes in. 
Anne Arundel county. When the municipal gov- 
ernment of Hyattsville was changed from a board 
of commissioners to a mayor and common coun- 
cil, Dr. Owens was elected councilman from the 
Third ward, and served with marked ability until 
May, 1906, when he was elected mayor. 

He was elected for three consecutive terms 
without opposition, and was foremost in every 
move tending to the advancement of the town. 
As treasurer of the [Maryland Agricultural Col- 
lege he became acquainted with many of the lead- 
ing men of the State, by whom he was held in the 



THE HOSPITAL BULLETIN 



39 



highest esteem. He was secretary of the Vans- 
ville Farmers' Club for many years, a director 
of the First National Bank of Hyattsville. Inter- 
ment was in the cemetery adjoining Old St. 
James' Protestant Episcopal Church, near West 
River Anne Arundel county. The coffin was 
home from his late residence, Hill Top Lodge, 
by seven cadets of the Agricultural College — 
Cadet-Major Mayor, Captains Burrough and Jas- 
sell, Lieutenant Jarrell and Sergeants Freere, 
Saunders and Cole. A squad of 25 cadets, five 
from each class of the College, under command 
■of Captain Gorsuch, escorted the body to Pinkey 
Memorial Church, where the Episcopal burial 
service was read by Rev. Henry Thomas, rector 
-of St. Matthew's Parish, of which Dr. Owens 
had been registrar and a member of the vestry 
for several years. The body, preceded by the 
college cadets, was taken to the Chesapeake 
Beach Railway Station and shipped to Lyons 
Creek, and thence to St. James' Church. Rev. 
Henry Thomas officiated at the grave. The pall- 
bearers were: Messrs. Wirt Harrison, Harry W. 
Dorsey, E. B. Owens, O. H. Carr, T. Sellman 
.Hall and E. A. Fuller. A special meeting of the 
Mayor and Common Council was held in Hepta- 
sophs' Hall March 22, 1909, to take action upon 
the death of Dr. Joseph R. Owens, late Mayor of 
Hyattsville. Acting Mayor John Fainter Jr., was 
chairman and Town Clerk G. H. Carr was secre- 
tary. Former Mayor Dr. C. A. Wells eulogized 
the late Mayor, both as a public official and a pri- 
vate citizen. Dr. Joseph A. Mudd, W. P. Magru- 
der, R. E. White, J. \V. Aman and Edward Dev- 
lin, all members of the Council who served with 
Dr. Owens, and R. W. Wells, M. J. Smith and 
S. J. Kelly, the last named as members of the 
present Council, also made appropriate addresses. 
It was resolved that in the passing away of Dr. 
Joseph R. Owens, Mayor of Hyattsville, we have 
lost a conscientious official, a valued associate and 
a personal friend, and the citizens of Hyattsville 
at large, as well as his official associates, have ex- 
perienced a bereavement, the effects of which 
they will ever feel. 



Dr. Asa S. Linthicum. class of 1852, a former 
member of the Board of County Commissioners 
of Anne Arundel county, died at his home, in 
Jessup, Mi, Sunday, March 28, 1909, from apo- 
plexy, aged 78. About 25 years ago Dr. Linthi- 
cum retired from the active practice of medicine 
to engage in iron ore mining. 

Dr. Linthicum's wife, who died about- five 
years ago, was Miss Nettie Crane, of Clifton 
Springs, N. J. Interment was in Loudon Park 
Cemetery, Baltimore. 



Dr. John Bailey Mullins, class of 1887, of 
Washington, D. O, a member of the American 
Medical Association and the American Society of 
Laryngocology and Otology, formerly of Nor- 
folk, Ya., died at his home, in Washington, D. 



C, from cerebral hemorrhage, February 11, 1909, 
aged 42. 

Resolutions on the death of Dr. John Bailey 
Mullins : 

Whereas, It has been God's purpose to sud- 
denly call hence one of our most useful and be- 
loved members ; be it 

Resolved, By the Washington Branch of the 
General Alumni Association of the University of 
Maryland, that we are deeply grieved by the pre- 
mature death of our honored associate. By his 
death the public, especially those worthy of char- 
ity, whom he was ever ready to serve, have lost a 
most useful citizen, the medical profession a 
skilled and painstaking physician and surgeon, 
and the University of Maryland an able and ac- 
tive worker. And be it further 

Resolved, That the sympathy of this Associa- 
tion be extended to his daughter, whom he loved 
before all else on earth, and to whom he was ever 
a dutiful father. And be it further 

Resolved, That these resolutions be spread 
upon the minutes of our Association and a copy 
of the same be sent to the parent Alumni Asso- 
ciation in Baltimore. 

Committee — I. S. Stone, William L. Robbins, 
Harry Hurtt. Monte Griffith, president: W. M. 
Simpkins, secretary. 



Dr. Samuel Groome Fisher, class of 1854. of 
Port Deposit, Md., died at the home of his son, 
in Port Deposit, February 22, 1900. aged "/J. For 
mure than 50 years Dr. Fisher was a practitioner 
of Chestertown, Md. 

Dr. Charles Brewer, class of 1855, of Vineland, 
N. J., died at his home, in Vineland, March 3, 
1909, aged 76. From 1858 to the outbreak of 
the Civil War he was a member of the Medical 
Corps of the Army, and during the war a surgeon 
in the Confederate States service. Under Presi- 
dent Cleveland he was postmaster at Vineland, 
N. J., and resident physician at the State Prison, 
Trenton, from 1891 to 1896. 



Dr. William F. Chenault, class of 1888, of 
Cleveland, N. C, a member of the Medical So- 
ciety of the State of North Carolina, died at his 
home, in Cleveland, N. C, February 24, 1909, 
from cerebral hemorrhage, aged 46. 



Dr. James B. R. Purnell, class of 1850, of 
Snow Hill. Maryland, died at his home, in Snow 
Hill, March 7, 1909, from senile debility, aged 80. 
He was vice-president of the Medical and Chirur- 
gical Faculty of Maryland in 1900-1901, formerly 
physician to the county almshouse and health of- 
ficer of Worcester county. 



Dr. Benjamin Franklin Laughlin, class of 
1904, of Kingwood, West Virginia, died at the 
home of his father, in Deer Park, Md., from 
paralysis, March 9, 1909, aged 31. 



IN PNEUMONIA the inspired air should be rich in oxygen and ccm- 
paratively cool, while the surface of the body, especially the thorax, 
should ba kept warm, lest, becoming chilled, the action of the phagocytes 
in their battle with the pneumococci be inhibited. 




(Inflammation's cAniidote) 

applied to the chest wall, front, sides and back, hot and thick, stimulates the 
action of the phagocytes and often turns the scale in favor of recovery. 

Croup. — Instead of depending on an emetic for quick action in 
croup, the physician will do well to apply Antiphlogistine hot and thick from 
ear to ear and down over the interclavicular space. The results of such treat- 
ment are usually prompt and gratifying. 

Antiphlogistine hot and thick is also indicated in Bronchitis and Pleurisy 



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ERTAIN as it is that a single acting cause can bring 
about any one of the several anomalies of menstrua- 
tion, just so certain is it that a single remedial agent 
— if properly administered — can effect the relief of 
any one of those anomalies. 

t]| The singular efficacy of Ergoapiol (Smith) in the 
various menstrual irregularities is manifestly due to its prompt 
and direct analgesic, antispasmodic and tonic action upon the 
entire female reproductive system. 

<J Ergoapiol (Smith) is of special, indeed extraordinary, value in 
such menstrual irregularities as amenorrhea, dysmenorrhea, 
menorrhagia and metrorrhagia. 

1§ The creators of the preparation, the Martin H. Smith 
Company, of New York, will send samples and exhaustive 
literature, post paid, to any member of the medical profession, 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 

PRICE $1.00 PER YEAR 

Contributions invited from the Alumni of the University. Entered at the Baltimore Post-office 

Business Address, Baltimore, Md. as Second Class Matter. 



Vol. V 



BALTIMORE, MD., MAY 15, 1909 



No. 3 



THREE ESOPHAGEAL CASES. 
By Richard H. Johnston, M. D., 

Lecturer on Laryngology in the University of 
Maryland, Surgeon to the Presbyterian 
Hospital, Baltimore. 
The esophagoscope has passed the experimen- 
tal stage in the diagnosis and treatment of esoph- 
ageal lesions. Its usefulness has been demon- 
strated so often that it would seem superfluous 
to dilate upon its value. Its use. however, is not 
as general as it should be. There are still those 
who consider esophagoscopy unnecessary or im- 
practicable. At the Presbyterian Hospital we 
have had numerous instances of its practicability, 
and with us it has become the routine practice to 
examine all patients complaining, of obscure 
esophageal symptoms. Dr. Chevalier Jackson re- 
cords the case of a patient whose only symptom 
was a lump on swallowing. She appeared to be 
a neurasthenic, and his advice to have the esoph- 
agus examined was ignored by the family physi- 
cian. Two months later, with the patient ether- 
ized for a radical antrum operation, he passed 
the esophagoscope and found a malignant 
growth. 

Three interesting cases have recently come 
under my observation, and they illustrate so well 
the value of the esophagoscope 1 shall report them 
Somewhat in detail. The first patient was seen 
with Dr. E. I!. Freeman; she was 67 years old. 
The morning before she came to the hospital. 
while eating ham. she swallowed a large piece 
that had not been sufficiently masticated. It 
lodged in the introitus esophagi and remained 
there. When she came to the hospital she had 
swallowed neither solid nor liquid food for nearly 
thirty-six hours. A half hour before examining 
the esophagus she was given a hypodermic of 
morphia and atropia. With the patient in the sit- 
ting position the throat and upper end of the 
K esophagus were anesthetized with 10 per cent, 
solution of cocaine. Jackson's laryngeal specu- 
lum was introduced and the larynx pulled for- 



ward. A large mass resembling somewhat an ul- 
cerative epithelioma was seen, and proved to be 
the piece of ham. Dr. Freeman and I removed it 
piecemeal with 1'fau's foreign body forceps. It 
required about forty-five minutes to remove it 
entirely. The patient stood the ordeal well, and 
was able to go home the same afternoon. For 
about a week she had temperature, cough and 
expectoration, but ultimately made a good recov- 
ery. In this ease the esophagoscope probably 
saved the patient an esophagotomy. The second 
patient was a female, thirty-three years old, re- 
ferred to me by Dr. J. F. Chisolm. of Savannah. 
While at an oyster supper she attempted to swal- 
low a large oyster, with the result that she choked 
for a few seconds and then had a sense id' fulness 
in the region of the larynx. The next day she 
had sonic difficulty in swallowing, so that she 
took only liquids. The second day afterward 
swallowing was decidedly painful: she grew rap- 
idly worse, until the fourth day her condition 
was serious. She reached this city the morning 
of the fifth day, with a temperature of 100 de- 
grees and extreme prostration. The examina- 
tion of the esophagus was made under ether with 
the head in the extended position. No foreign 
body was found, but the upper end of the esoph- 
agus was red, swollen and edematous, and seemed 
to be closed. The patient was given cold milk 
and ice bags to the throat. For two days she 
suffered excruciating pain 011 swallowing, and it 
looked as if we would have to resort to rectal 
feeding". The next clay there was slight amelio- 
ration of the pain, which gradually disappeared. 
In this case the esophagoscope enabled us to see 
at once that a foreign body was not present, and 
that the symptoms were due to a severe, acute in- 
flammation, probably caused by a piece of shell 
attached to the oyster. 

I was asked by Dr. A. M. Shipley to examine 
a patient who had been referred to him for prob- 
able cancer of the stomach. The man was sixty 
years old and had had some trouble in swallow- 
ing for about two months. Attempts to pass the 



42 



THE HOSPITAL BULLETIN 



stomach tube were unsuccessful. The patient 
was examined in the sitting position after cocaine 
anesthetization. No difficulty was experienced 
in passing the esophagoscope. About three 
inches below the cricoid cartilage the progress of 
the instrument was arrested by a tumor partially 
closing the esophageal lumen. The esophago- 
scope showed that the tumor was too low for re- 
moval. In this case the patient can be dilated 
through the esophagoscope and made more com- 
fortable for the short time he has to live. 
919 North Charles street. 



SYPHILITIC OSTEOPERIOSTITIS. 

By C. G. Moore, '09. 

Senior Medical Student. 

The bony manifestations of syphilis occur as 
secondary and tertiary lesions, and as Keyes, of 
New York, has pointed out, these so-called 
"nodes" are simply local periosteal congestions, 
accompanied by serious effusions without cell hy- 
perplasia. Any bone in the body may be affected 
by syphilis, but certain of them suffer by prefer- 
ence, such as the thin bones of the nose and 
pharynx — that is, those exposed to climatic 
changes and injuries, such as the bones of the 
skull, ulna, tibia, etc. 

We must call special attention to injur}' as a 
powerful pre-disposing cause of bone syphilis, 
for, when we consider that bone lesions may be 
the only manifestations of existing syphilis, with 
the presence of a bone lesion before us, with an 
antecedent history of an injury, we must not for- 
get that we may overlook the true nature of the 
disease, and hence must be constantly on the alert 
for the syphilitic taint. 

Lancereaux classified the bone lesions under 
three heads, viz. : 

(a) Inflammatory osteo-periostitis. 

(b) Gummy tumor of bone. 

(c) Dry caries, atrophic form. 

(1) Inflammatory osteo-periostitis is the most 
frequent form, and is characterized by inflam- 
matory phenomena, vascularization and exuda- 
tion of a serio-glutinous material. It may be 
either diffuse or circumscribed, and located, as 
its name implies, in the area of contact with the 
osseous and periosteal surfaces. The pain is 
aching, acute, throbbing or boring in character, 
while tenderness upon pressure and percussion is 
most exquisitely excruciating. The diagnosis of 
inflammatory osteo-periostitis is comparatively 



easy, if we remember the characteristics, viz., an 
oval, painful, boggy or even hard bony lesion, ac- 
companied by nocturnal exacerbations of pain, 
with a concomitant or antecedent history of syph- 
ilis. Ostitis with parenchymatous thickening is 
somewhat less positive in its character, but with 
nocturnal pains which are usually constant. 

(2) Gummy tumor of bone develops either 
under the periostum, in the substance of bone, or 
in the medullary canal. It is simply an intensifi- 
cation of the process found in the inflammatory 
form just described, the difference being that the 
cell hyperplasia is more abundant. Much of the 
new material collects in a circumscribed space, 
and being more rapidly formed and less capable 
of organization, it entails more profound lesions 
by its retrograde metamorphosis. Generally tu- 
mor of the bone is, therefore, a much more se- 
rious form of disease than osteo-periostitis. 

In the long bones the medullary canal is the 
usual seat of deposit. The bone becomes hyper- 
trophicd in a porous manner, the Haversian 
canals and canaliculi become enlarged and filled 
with a gummy material which resembles a solu- 
tion of gum arabic. In the flat bones, especially 
the cranial bones, the cancellar tissue is attacked, 
and may cause a separation of the two tables, and 
often necrosis of one or the other plates results. 
If it happens to be the inner one which undergoes 
carious degeneration, brain symptoms will de- 
velop. 

(3) Dry Caries. — According' to Virchow, dry 
caries is always due to syphilis. This affection 
is a miniature gummy ostitis. Around one of the 
vascular canals the gummy material is deposited, 
this gummy material being later absorbed, leav- 
ing a stellate induration. This goes on leaving a 
a funnel-shaped depression, its point leading into 
the diploe, which may be plainly appreciated by 
palpation. The essential features of this caries is 
the fact that no sequestra are formed, no pus ex- 
truded, nor is the skin but rarely involved. 

The following is a case of syphilis in which 
osteo-periostitis developed : 

On January 22nd. 1909, R. B., age 35, white, 
a housewife, applied to the Medical Department 
of the University Hospital Dispensary for treat- 
ment, complaining of rheumatism in her back 
and a sore shin. The patient has been married 
14 years and has bad four children; the two eld- 
est are the only ones now living. Three years ago 
she gave birth to a full-term child which only 
lived a few minutes after expulsion. 



THE HOSPITAL BULLETIN 



43 



One year later she gave birth to another child, 
which was not at full term, but about six months 
advanced. She says two days previous to this 
birth she fell down stairs and struck on her abdo- 
men. When the child was born its thigh was 
fractured, and the physician who attended her 
said the fracture was caused by the fall. 

Her father died nine years ago, at the age of 
68 years, of apoplexy; her mother was killed a 
few years ago in an accident. She has two broth- 
ers and three sisters, all living and in good health, 
as far as she knows. She is at present living 
with her husband, and says he is apparently well 
and sound, but drinks heavily, and when under 
the influence of liquor abuses her a great deal. 
Patient denies ever having had tuberculosis, 
syphilis, diphtheria, typhoid, scarlet fever, ma- 
laria, grippe, gonorrhoea, or any of the nervous 
or malignant diseases. She sometimes has a sore 
throat when she takes cold, but it only lasts a few 
days. She has complained of rheumatism in her 
back and limbs for the past three or four years, 
and thinks it is worse at night. 

Patient never complained of any trouble other 
than those mentioned until three years ago, when 
her third child was born. She says that at that 
time her hair fell out, and an eruption, which 
itched slightly, broke out all over her body, in- 
cluding her face, but only extended down her 
arms as far as her wrists. This lasted a few 
weeks, then seemed to subside, but never entirely 
disappeared, and when she gave birth to the 
still-born child, one year later, it broke out again 
worse than before. She went to Dr. McElfresh, 
who treated her for about three weeks, giving 
her some medicine to take internally, also some 
sulphur ointment. She for a time got some bet- 
ter, but owing to her circumstances was unable 
to continue treatment with Dr. McElfresh, and 
has done nothing for her condition until the pres- 
ent time. For the past four months she has been 
suffering with a pain in her right shin ; this has 
been gradually getting worse, and one week ago 
began to swell and cause her considerable pain, 
being worse at night, and sometimes hurting 
her so much that she is unable to sleep, hence her 
reason for coming to the dispensary. 

Upon questioning her in regard to her general 
health, she says she feels as well as she ever did, 
with the exception of the previously mentioned 
pain. 



Her appetite and digestion are good, and her 
bowels are regular, and she has no lung, heart or 
kidney trouble. She has had no headaches, 
nausea, or vomiting, and her menstrual periods 
have always been regular and painless. 

Upon examining patient I found her to be well 
nourished and well developed, weighing 142 
pounds. Her color was good and her pupils about 
normal in size, reacting to light and accommoda- 
tion. Both patella reflexes were absent, also 
Romberg's sign, and there was no enlargement 
of the mastoid, epitrochlear, post-cervical or in- 
guinal glands. Her pulse was 84 to the minute, 
regular in rate and force. The tension and 
volume was good; her temperature was 98.6°. 
Her heart was normal in size, and on auscultation 
the sounds were clear and no murmurs were 
heard. The expansion of both lungs was good, 
the respirations being 20 to the minute. 

Percussion and auscultation were negative ; all 
the abdominal organs seemed to be normal. There 
was an ecchymotic area under her left eye, which 
she says was caused by her husband striking her 
two years ago when intoxicated. 

There was a circular reddish macular papular, 
non-itching eruption which does not disappear on 
pressure, varying from the size of a bird shot to 
that of a nickel, and is confined to her back, chest, 
shoulders and arms, most profuse on the left side, 
and is not seen on the lower limbs at all. On her 
left shoulder some of these lesions have devel- 
oped into pustules, which have become infected 
and slightly ulcerated ; these give her slight pain. 

In the corner of her mouth is a scar which 
looks like the initial sign of lues, but she claims 
it appeared a few weeks after the breaking out 
on her body. On examining her mouth no mu- 
cus patches or scars were found. 

She now has an osteo-periostitis on the anterior 
aspect of her right tibia. It is moderately 
swollen, slightly reddened, and is very painful 
(the pain is aching, acute and boring in charac- 
ter) on pressure, and on tapping the bone with 
my finger above and below this point it caused 
her intense pain. (Patient claims she has never 
received any injury in this location.) 

Upon consulting Dr. McElfresh, he remem- 
bered the case and said that he had treated her 
for a short time about two years ago for the in- 
itial symptoms of syphilis, but since then has 
never seen her. 



44 



THE HOSPITAL BULLETIN 



She is now receiving- the mixed treatment of 
protiodid of mercury, gr. )/\, with a saturated so- 
lution of potassium iodid three times a day, start- 
ing her on ten drops, then increasing it one drop 
each time taken. I requested her to return when 
the medicine is finished. 



DISCUSSION BY DR. WARNER HOLT, OF 
WASHINGTON, OF THE PAPER ON 
THE CHEMICAL CO-RELATION BE- 
TWEEN THE SALIVARY GLANDS AND 
THE STOMACH, BY JOHN C. HEM ME- 
TER, OF BALTIMORE. 

Read Before the Society for Experimental Biol- 
ogy and Medicine, of New York, Meeting in 
the Rockefeller Institute for Medical Research. 
on December if), 1908. 

Dr. Holt said in part : "This experimental 
study by Dr. Hemmeter is not, as it might appear 
to be, only an inquiry into the physiology of a 
limited part of the digestive apparatus, but it is 
an attempt to solve a biologic problem and to get 
at the broad basic principles that underlie the 
chemical co-relation of the organs. 

"When a worker occupies himself with the ef- 
fect of the extirpation of one organ of digestion 
upon the organs in the next segment of the di- 
gestive apparatus, he naturally thinks of phe- 
nomena of exclusion or loss of function in one or 
the other of the segments following the one ex- 
tirpated, but instead of phenomena of exclusion 
it is conceivable that those of exaggerated activ- 
ity in the other segments of the digestive tube 
might result. 

"For 'a priori' we cannot know whether the in- 
fluence that one segment of the digestive tract 
exerts upon the succeeding segment is that of 
stimulation or of inhibition, or of both, viz., of 
stimulation under one set of conditions and inhi- 
bition under another set of conditions. In the 
investigation of the problem of a chemical co-re- 
lation between the salivary glands and the stom- 
ach, Dr. Hemmeter has done meritorious work, a 
great part of which it has been my good fortune 
to observe and assist in personally : though I am 
a physician in the employment of the government 
at Washington, I consider myself a post-graduate 
student of Professor Hemmeter. I have seen 
personally four of his animals that had success- 
fully been nursed through the Pawlow operation 
and extirpation of the salivary glands after 
months of the most trying work. It required a 



great deal of perseverance to persist in this kind 
of work, especially when some of the best ani- 
mals that had emerged safely from the vicissi- 
tudes of the operation for an accessory stomach 
and from the removal of all the salivary glands 
on one side of the head succumbed to the third 
operation in the attempt to remove the remaining 
salivary glands on the other side. 

"The history of these operative failures, though 
they will never be told, constitute a large part of 
the merit of those who have worked with Dr. 
Hemmeter in this research. No matter what the 
final outcome of the future investigation of this 
problem will be, whether affirmative or negative, 
the intrinsic value of such work will be appre- 
ciated by all who are to the least degree conver- 
sant with the history of physiology. Nowadays 
we are too liable to forget the hard plodders in 
experimental work who have started the solution 
of a problem, and when the last word has been 
said the worker of the beginning is generally for- 
gotten. 

"In this connection I desire to quote an expres- 
sion of Prof. William II. Welch concerning the 
merit of the work of ex-Surgeon General Stern- 
berg, done since the first Yellow Fever Commis- 
sion was appointed, in 1879 (see Medical News. 
June 21, 1902. p. 1198). Dr. Welch said 'that, 
Sternberg's work with yellow fever would stand 
forever ; that it was a common thing in these 
busy days to forget the steps which led up to an 
important discovery. All that Dr. Sternberg had 
done in the study of yellow fever was necessarv 
work, and it had to be done just in the way that 
he did it. The ground had first to be cleared. If 
it were not so, the discovery had not been pos- 
sible ; and later discoverers themselves would 
have had to hunt out the large host of microor- 
ganisms which Dr. Sternberg had described and 
laid aside.' 

"And similarly I can say of Dr. Hemmeter 's 
efforts that, no matter what the eventual outcome 
of this problem will be, all that he has done was 
necessary work, and it had to be done just in the 
way that he did it. 

"Just one more idea and I shall have finished. 
It concerns the demonstration of such research 
work in places at a distance from the experiment- 
or's laboratory. Such demonstrations are always 
attended with great difficulty. They usually re- 
quire four animals, two or three janitors to trans- 
port them, and as many laboratory assistants as 



THE HOSPITAL BULLETIN 



45 



the director of the laboratory can manage to take 
with him. The technique of these operations, the 
high-grade sensitiveness of operated animals, the 
refinement with which chemical tests should be 
made, all require for their safe conduct that the 
experimentor should work only with those men 
who are used to his system. The animals them- 
selves are always influenced in one way or other 
by the presence of strangers. I remember in one 
animal which was demonstrated on March 17th. 
at the University Hospital, the demonstration at 
which Dr. Satterthwaite was present, a most un- 
expected change in the quality of the gastric se- 
cretions took place. This was a control animal 
which had undergone no operation whatever. He 
was simply taken along to show the proteolytic 
power of a normal dog and compare it with the 
operated dogs. His gastric juice had been pre- 
viously tested on several occasions, and always 
found to be of regular standard, but on the 
night of the demonstration before the .Medical 
Society this animal's gastric juice was practically 
inactive, containing no HCL nor pepsin. 

"Dr. Hemmeter has already informed you that 
in some animals the loss of gastric juice after ex- 
tirpation of the salivary glands is only temporary, 
and that in varying time — in some cases three 
weeks, in other animals three to four months — 
there is a gradual resumption of gastric secretion. 
This resumed secretion, however, never becomes 
as effective as it was in the same dog before an 
operation. The question when to begin to make 
observations on an operated animal depends en- 
tirely upon the state of this animal; if the dog 
eats his food with appetite he has no fever, and 
his digestion appears to be satisfactory : then the 
observations may be begun, even if it is only one 
week or ten days after the last operation. ( )ne 
of the most valuable animals that was used in 
this series of experiments was so injured in the 
effort to transport him to another laboratory that 
he could not be used for further experimentation. 
The dog struggled so in his holder while he was 
being transported in a wagon that the partition of 
true mucosa which separates the accessory from 
the plain stomach was broken through. This had 
happened once before in transporting a dog from 
the laboratory to Dr. Hemmeter's country place, 
and his associates in the Medical Faculty, becom- 
ing aware of the great labor and cost involved in 
such operations, and the rarity with which they 
succeed, advised that no further Paw low dogs be 
sent to other laboratories." 



AN INTERESTING CASE OF SCROTAL 
HERNIA. 

By G. E. Bennett, '09. 

Senior Medical Student. 

Patient — Ge< irge Kolubaher. 

Age — Sixty-six years. 

Occupation — At present a farmer: formerly 
worked as laborer in stone quarry. 

Complaint — Patient entered the hospital on 
January 21, 1909, complaining of great pain and 
discomfort in the right inguinal region and in the 
scrotum of the same side. 

Physical Examination — Inspection showed an 
enormously enlarged scrotum, more marked on 
the right side, and a prominent swelling along the 
right inguinal canal, which was most marked 
when standing. Marked discoloration on the 
skin of the scrotum and inner side of both thighs, 
probably due to use of counter-irritants. 

Palpation — Mass soft and freely movable, 
showing no skin attachments ; slight impulse on 
coughing. Slightly painful on pressure. Some 
gurgling when manipulated. 

Percussion — Slightly tympanitic. 

Remarks — Contents of the sacs were forced 
into abdominal cavity after prolonged manipula- 
tion, returning to original condition as soon as 
pressure was taken away. 

History of patient shows nothing of interest 
except that of the present condition, which began 
suddenly twenty years ago. While lifting a 
heavy block of stone had a feeling as though 
something had "given away" in his right side. 
This sensation was immediately followed by one 
of intense pain and general discomfort. The day 
following the patient noticed a small lump in the 
right inguinal region that disappeared on pres- 
sure, returning when he lifted any heavy object. 

For eighteen years the condition gave him no 
serious discomfort except for the wearing of a 
truss and becoming larger. Two years ago the 
truss was discarded as being useless. 

One week ago conditions grew suddenly worse, 
and patient was confined to bed. Has suffered a 
great deal of pain and has been unable to sleep. 

On Januarv 22, 1909. patient was operated 
upon by Professor Winslow. Operation as fol- 
lows : 

Patient was brought to the operating room at 
11.30 A. M., anesthetized and prepared for an 
aseptic operation. 



46 



THE HOSPITAL BULLETIN 



Incision about five inches in length was made 
parallel to Pouparts ligament and immediately 
over the inguinal canal, passing through the skin 
and subcutaneous fat. The external ring having 
been exposed a grooved director was passed into 
same, passing under the aponeurosis of the ex- 
ternal oblique muscle; fibers of same were split, 
using the director as a protective guide. The 
sac was exposed and carefully dissected free 
from its surrounding tissues, and upon examina- 
tion was found to be continuous with the cover- 
ing of the testacle (giving the appearance of a 
congenital hernia). The sac was next opened 
and found to contain small intestines and a Meck- 
el's diverticulum. Following this the intestines 
were replaced in the abdominal cavity. Digital 
examination through the internal ring showed the 
bladder to be adherent to the peritoneum at the 
margin and toward the median line. The sac was 
tied close to the internal ring, cut free. The 
distal portions of the sac were drawn upward, 
bringing the testacle into view ; sac was cut close 
to same and sutured so as to enclose the greater 
part of it. 

The margins of the internal oblique and trans- 
versalis muscles were sutured to Poupart's liga- 
ment by a mattress suture. The aponeurosis 
of the external oblique was re-established into 
normal position by suturing, and the skin closed 
by subcutaneous silver wire suture silk having 
been used for all other sutures. 

Sterile dressings were then applied and card- 
board splints to keep limb immobile. Then ban- 
daged with crenolin. The patient left the operat- 
ing room at I P. M. in good condition. 

Notes of Interest — 

That a hernia, apparently congenital, should 
not have made an earlier appearance. 

The presence of a Meckel's diverticulum in the 
sac, this being the condition that gives rise to a 
true Richter's hernia. 

That a hernia of so large proportion should 
have caused so little trouble to the patient. 

Patient recovered in very short time, leaving 
the hospital in good condition. 



THE TEACHING OF THE SPECIALTIES. 

By Hiram Woods. M. D. 
Read Before the University of Maryland Medi- 
cal Association, April 21, 1909. 

Teaching specialties to undergraduates must 
be carefully separated from the same teaching to 



post-graduate students. The latter may be sup- 
posed to have given such thought to their future 
career as to have reached the conclusion that they 
wish to devote themselves to a certain line of 
work. It is not these men whom I propose to 
discuss, save to say, in passing, that the average 
six weeks' or two months' course offered bv post- 
graduate schools is totally inadequate. As a rule 
such courses attract a large number of men who 
do little more than follow the clinical work of 
some well-known specialist and pick up what 
they can. Either prolonged hospital experience, 
as interne or clinical assistant, or a special indi- 
vidual course, with a competent teacher, is needed 
for a decent foundation in special work. 

It seems to me that with undergraduate work 
the first important step is to secure the attention 
of the men, and convince them that there is some- 
thing in the special course worthy of notice. 
There is a state of mind, not unnatural to the 
undergraduate, regarding specialties. Most of 
them propose to begin professional life as gen- 
eral practitioners. They think they will never 
have use for knowledge in the so-called special- 
ties, and that the little they will need in order to 
get a passing mark can be easily crammed at the 
close of the session. As a matter of fact, it is 
easy to frame questions so that this "crammed" 
information is of little use, and the most liberal 
grading hardly ever brings such men up to a 
passing mark. The mental attitude of these men 
is unjust to themselves, their teacher and the 
patients who, in the near future, will entrust to 
them their physical welfare. The very term 
"general practitioner" implies a general knowl- 
edge of medicine. If one lives in a .city, where 
the services of specialists are readily obtained, he 
may, if he desires, refuse certain cases, and take 
only such as he wants — say such as belong to in- 
ternal medicine. But in so doing he becomes a 
specialist himself, and if he has neglected a 
properly prepared special course for undergrad- 
uates while a student he will miss information of 
great use to him as an internist. Many men, 
however, do not practice where specialists are 
easily obtained, and, perforce, must take cases 
which would logically come under one or other 
of the recognized specialties. Here is a profes- 
sional responsibility which it is the aim and duty 
of a special teacher to enable his student to meet. 
May I illustrate by directing attention to two 
troubles which it is my own privilege to explain 
to our students? Iritis, in eye, and acute otitis 



THE HOSPITAL BULLETIN 



media, in ear diseases, are very common troubles. 
Both are, as a rule, readily diagnosed, and both 
offer good prognosis. Yet the responsibility for 
eyesight in one, and may be life in the other, may 
depend on the diagnostic ability and therapeutic 
resources of the man who first sees the case. Men 
are blind and children dead because a general 
practitioner has not known enough of what was 
offered him when a student to make a correct di- 
agnosis. The red eye has been called conjuncti- 
vitis and treated with nitrate of silver, in spite of 
the absence of purulency, while the small, inac- 
tive pupil has escaped notice. The ear pain has 
been called "earache" without an aural examina- 
tion, a hops bag and opium have been ordered, 
and the doctor has gone home with that false 
sense of security which is so dangerous. Why? 
If his teacher has known his business, it is not 
because he was not told how to look for iritis and 
acute inflammation of the drum, but because he 
had not given the subjects sufficient thought to 
get them drilled into his thinking apparatus. 
Probably he could tell the diagnostic points of 
iritis, if asked, or the signs of ear-drum inflam- 
mation ; but this was "crammed" information, 
not part of his real knowledge. 

If it is the duty of the student, anticipating 
general practice, to think about the specialties 
taught during his undergraduate course, it is still 
more the duty of his teacher to present him only 
such things as the general man needs. He will 
make a grievous blunder if he tries to make spe- 
cialists of his men. His selection of subjects 
should be limited to the diseases which are of 
common occurrence, and stress should be laid on 
diagnosis. If one knows, first, what to look for, 
and secondly how to recognize signs and symp- 
toms, he will generally find proper treatment. 
Troubles which would lead the patient to go to 
the specialist primarily, without consulting his 
family physician, should receive little attention. 

Two other classes of lesions in such organs as 
are usually handed over to specialists should re- 
ceive attention in the undergraduate course — 
those which are apt to cause remote or reflex dis- 
turbances, and those which are definitely symp- 
tomatic of central lesions. The first should, in 
my judgment, be dwelt upon only to such an ex- 
tent as to enable the student to know causative re- 
lation and method of diagnosis. Treatment, un- 
less very simple and easily within the reach of the 
medical man — i. e.. the general practitioner — 



should be given little time. As to the second 
class, every neurologist knows that Tabes Dor- 
salis would often be diagnosed early, and proper 
treatment instituted, if the physician had known 
the meaning of association of gastric crises with 
Argyll-Robertson pupil, and had seen enough of 
these things to have them in his every-day 
thoughts. One could present many other illus- 
trations, but this shows what is meant. With 
the student convinced of the necessity of think- 
ing about the specialty taught, the instructor 
careful in selection of his subjects, a duty rests 
on those who fix the curriculum. 

It is unfair to students to use four years for 
work which can be done in three. I believe that 
the object of the establishment of a four-year 
course was to furnish a year in which students, 
freed from the responsibility of examinations, 
might have time for guidance in clinical observa- 
tion. The ideal plan, in my judgment, is to get 
rid of didactic lectures and examinations by the 
end of the third year, and to devote the fourth 
to clinical observation. Genito-urinary work, 
gynaecology, rhinology, neurology, ophthalmol- 
ogy, otology, cannot be learned from text-books 
or lectures, at least in such a way as to become 
integral parts of a man's daily thinking. And to 
my mind this is the only special information 
which will help the general practitioner in his 
daily work. A few hours spent in a large clinic 
brings more instruction than a whole year of lec- 
tures. The personal contact of man to man, the 
exchange of thoughts and impressions, are what 
sink in. A student is not to be blamed if he fails 
to attend these opportunities when he knows that 
in a few weeks he must face the ordeal of exami- 
nations on the didactic work, and that the result 
of these will determine his graduation. To put 
into a few words my idea of teaching specialties 
— it is the duty of the student to realize that 
nothing is put into the undergraduate course 
which is not important to him; it is the duty of 
the teacher to select only what is important to the 
general practitioner ; it is the duty of the school 
authorities to so arrange the curriculum as to 
give students enough time to observe special 
practice personally, in small sections, so that 
what is taught may be so impressed by observa- 
tion as to become a real factor in their medical 
thought. 



48 



THE HOSPITAL BULLETIN 



A CASE OF SPORADIC CRETINISM. 

r»Y E. Sanborn Smith, M. D.. 

Class of 1900, Macon, Mo. 

Karl B. is the son of sturdy parents, both of 
whom were born and reared in the Swiss Tyrol. 
I Ie had never developed like the other children — 
was, in fact, much smaller at five and a half 
years than the fourteen-months-old baby. He 
was dull, placid, taking no note of his surround- 
ings, sitting or lying just where he was left, and 
never evinced any disposition to play or converse 
with the other children. I saw this child on the 
4th day of January, 1908. in a purely accidental 
manner. The parents had been told by their at- 
tendant that the child bail either rickets or was 
an idiot, and they in consequence had kept the 
child in the background for two or three years, 
being very much chagrined and mortified at the 
prospect of bearing through life the burden of 
hopeless idiocy. The child had such classical 
symptoms of cretinism that 1 asked permission of 
the family to treat him for awhile, though it re- 
quired some persuasion, because of the fact that 
they felt it was time and money wasted. On the 
5th day of January. n>o8, the child was five 
years and a half old. twenty-eight inches in 
height, circumference of chest twenty-one, abdo- 
men twenty-three. He was given one and one- 
half grains of thyroid extract twice daily, the 
dose being gradually increased until he showed 
signs of irritability, with accelerated pulse. The 
child's extremities soon warmed up, the circula- 
tion became better, the hair began to grow, the 
child for the first time in its life walked and 
talked, began to take note of surroundings and 
to play with the other children. 

Just one year after the beginning of the treat- 
ment — January 5, 1909 — the child was thirty-five 
and three-quarter inches in height, chest twenty- 
three, abdomen twenty-three. 

This disease, sometimes known as cretinoid 
or myxoedematous idiocy, was first described by 
Fagg in 1871. Since then a number of cases 
have been published, both in England, on the 
Continent and in America, showing that the dis- 
ease is not confined to any one country. While 
the disease is comparatively rare, cretins are more 
common than was formerly supposed. The dis- 
ease seems to be in reality a pachydermatous 
cachexia, and it is now. I believe, well estab- 
lished that it is caused by congenital absence of 
the thyroid gland or to the presence of something 



which abolishes its functions. Little is known as 
to the causes of its destruction or abolishment of 
function. As a rule only one case occurs in a 
family, the other members presenting nothing 
abnormal in their mental or physical develop- 
ment, hence the term sporadic. It has been more 
frequently reported in the Tyrol, in Switzerland, 
a coincidence which makes this child's case all the 
more interesting, in that both its parents are 
physically and mentally well up to par and the 
other children possess even more than the aver- 
age intelligence. 

Symptoms — The symptoms are practically 
identical with those of the myxoedema which fol- 
lows the removal of the thyroid gland in adults. 
The symptoms of cretinism in most cases in in- 
fants make their appearance during the first year, 
occasionally, however, not until the child is three 
or four years of age. The appearance of the cre- 
tin is very striking, and so characteristic that 
when once seen the disease can hardly fail to be 
recognized. The child is much dwarfed, the 
fingers and toes are short and stumpy, the cuta- 
neous tissues seem to be thick and boggy, but do 
not pit on pressure, as in ordinary oedema. The 
facies is extremely characteristic. The head 
seems large for the body, the fontanel is open 
until the eighth or tenth year, the forehead is low 
and the base of the nose broad, so that the eyes 
seem unusually wide apart. The lips are thick, 
the mouth half open and the tongue protrudes 
slightly, the cheeks are baggy and the hair is 
coarse, short and straight, and the skin has the 
peculiar leathery feel of elephant skin. The ab- 
domen is pendulous, large, streaked with promi- 
nent veins, and reminds one of rickets. The skin 
is dry, the voice husky and rough. There is but 
one word which describes the peculiar clumsy 
manner of walking — that word is waddle. The 
child actually waddles like a duck. The tempera- 
ture is always subnormal, and one of the things 
the mother will always call to your attention is 
the fact that the child has such cold hands and 
feet and requires so much more cover than the 
other children. Cretins are dull, placid and good 
natured, never quarrelsome. 

Treatment — There is no tendency toward spon 
taneous improvement. These cases have until 
the last few years been considered hopeless and 
condemned to a life of idiocy. Really, in the 
treatment of cretinism in the adult marvelous re- 
sults have been got from the administration of 



THE HOSPITAL BULLETIN 



49 



the dried and dessicated extract of the thyroid 
gland of the sheep. This has led to its use in the 
myxoedema of infancy. The results are astound- 
ing. The child grows mentally and physically, 
takes note of surroundings to which it formerly 
paid no attention whatever, and can be taught al- 
most as well as a perfectly normal child. In all 
cases the thyroid extract must be kept up indefi- 
nitely, the dose being gradually increased, other- 
wise the improvement ceases at once. 



ITEMS. 

At the commencement of the University Hos- 
pital School for Nurses, held May 5th, the fol- 
lowing nurses received their diplomas. The ad- 
dress to the graduates was delivered by Dr. A. 
M. Shipley: 

Miss Elizabeth Getzendanner was the president 
of the class, and Miss Lucy B. Squires was the 
secretary. 

Those who received diplomas were : 

Miss Catherine Mabel Dukes, Maryland. 

Miss Anna May Green, North Carolina. 

Miss Laura Schley Chapline, West Virginia. 

Miss Louise Dorsey Pue, Maryland. 

Miss Grace Schoolfield Tull, Maryland. 

Miss Annie Lou Wahm, South Carolina. 

Miss Eva Sidney Chapline, West Virginia. 

Miss Beulah Ophelia Hall, Georgia. 

Miss Elizabeth Getzendanner, Maryland. 

Miss Emily Lavinia Ely, Maryland. 

Miss Lucy Bright Squires, North Carolina. 

Miss Gertrude Hedwig Tews, Germany. 

Miss Helen Mary Robey, Maryland. 

Miss Blanche Almond, Virginia. 

Miss Lillie Booker Carter. Virginia. 

Miss Mary Barton Saulsbury, Maryland. 

Miss Vera Wright, Maryland. 



The alumni of the University will be pained to 
learn of the recent illness of Prof. S. C. Chew. 
The Bulletin is glad to report that he is now 
convalescing. No member of the Faculty is more 
esteemed and beloved than is Professor Chew. 



Dr. Leonard O. Sloane, of Juneau, Alaska, 
who has been visiting Baltimore for several 
weeks, has left the city. He came to this city to 
avail himself of the opportunities for clinical in- 
struction offered by this University, and was 
much pleased with the work he was able to see 



at the University Hospital, the Woman's Hos- 
pital, the Hebrew Hospital and at Bay View. He 
is physician to St. Ann's Hospital, at Juneau, and 
is a progressive and able member of our profes- 
sion. 



In the recent examinations held for commis- 
sions in the medical corps of the United States 
Army, Dr. J. S. Fox, one of the surgeons at the 
St. Francis Xavier Hospital, was a successful 
contestant, and the War Department has notified 
him that he will be commissioned a first lieuten- 
ant and will be ordered to proceed to a post in the 
West. One hundred doctors took the examina- 
tion for the appointments, but only thirteen were 
successful. Dr. Fox, who will be one of the 
youngest surgeons in the Army, was high up in 
the list of the fortunate ones. 

Dr. Fox is a son of the late Dr. T. S. Fox, of 
Batesburg, who was a distinguished surgeon in 
the Confederate Army. He is a nephew of Mr. 
J. T. Fox, of that town. Dr. Fox is twenty-nine 
years of age, and was born in Batesburg, S. C. 
After completing the high school at that place 
he entered Richmond College, Richmond, \ a . 
and was there for three years, when he entered 
the Medical College at Baltimore. Fourteen 
months ago he came to Charleston to accept an 
appointment as one of the house surgeons of the 
St. Francis Xavier Infirmary, and during his stay 
in this city has made a fine record for himself, 
and now has many friends here. 

As soon as his commission arrives he will leave 
here for Fort Sam Houston, Texas, the station 
designated in the orders of the War Department. 
There are at present several troops of the Third 
Cavalry and a battalion of light artillery from the 
Third Field Artillery Regiment stationed at this 
important post, which is considered to be one of 
the most agreeable army posts in the South. On 
October I, Dr. Fox will be ordered to report to 
Washington, where he will be detailed to attend 
the Army Medical College for a period of eight 
months. 



The Council on Pharmacy and Chemistry and 
the Board of Trustees of the American Medical 
Association have adopted a vote of thanks to 
Daniel Base, Ph. D., professor of analytical 
chemistry. Department of Medicine, University 
of Maryland, for his co-operation and assistance 
in investigating products and for special research 
work done at the request of the Council. 



50 



THE HOSPITAL BULLETIN 



It has been definitely decided that the new op- 
crating room which is to be built at St. Joseph's 
Hospital is to be dedicated to the memory of Dr. 
Isaac Ridgeway Trimble, who died of septicemia 
after performing an operation upon an infected 
kidney at the hospital, as a result of which the 
patient lived. A tablet bearing Dr. Trimble's 
name and the incidents surrounding his martyr- 
lik-e death will be placed in the operating room. 



Dr. John R. Winslow read a paper on "A Case 
of Tuberculosis of the Fauces and Lingual Ton- 
sils, Caused by Tuberculin Injections," before the 
Section on Laryngology and Rhinology, Friday, 
March 26, 1909. At the same meeting Dr. J. N. 
Reik read a paper on "The Present Status of the 
Surgical Treatment of Purulent Disease of the 
Nasal and of the Aural Cellular Spaces : a Com- 
parison." 



Dr. and Mrs. A. Duvall Atkinson, who have 
been spending a few days in Washington, have 
returned to their home, 924 North Charles 
street. 



Under the title of leading men of Maryland, 
"The Star" has this to say concerning Dr. Louis 
McLane Tiffany: 

Dr. Louis McLane Tiffany is not only one 
of the best-known men in Maryland, but en- 
joys a reputation that is international as an op- 
crating surgeon. He has performed success- 
fully many unusual and difficult operations, 
and has contributed much to his profession by 
original research. He was born in Baltimore, 
October 10, 1844, and is related to the well- 
known McLane family of Maryland and Dela- 
ware. He received his bachelor of arts degree 
from Cambridge University, England, in 1866, 
and upon his return to Baltimore entered the 
University of Maryland as a medical student, 
his degree as doctor of medicine being con- 
ferred upon him in 1868. He soon attained 
prominence in his chosen work. For many 
years he has been professor of the principles 
and practice of surgery at the University of 
Maryland. He has been operating surgeon of 
many of the Baltimore hospitals, has per- 
formed operations on prominent persons all 
over the countrv, and is the author of a num- 



ber of treatises on particular phases of surgery. 
Dr. Tiffany helped to found the Maryland 
Clinical Society, is a member of the Medical 
and Chirurgical Faculty of Maryland and an 
active or honorary member of many other so- 
cieties. 



Recently there was unveiled at St. Tim- 
othy's Church, at Catonsville, Md., a beautiful 
memorial window designed and executed in 
Favrile glass to the memory of Dr. Charles 
G. W. Macgill, who was president of the First 
National Bank of Catonsville and a physician 
widely known in that part of Baltimore coun- 
ty. This memorial, the subject of which is St. 
Luke, is in three panels, the figure of the evan- 
gelist being in the center opening, while a 
splendid landscape is carried out in the two 
side panels. On a scroll carried by St. Luke is 
the text: "For to one is given by the Spirit the 
gifts of healing." 1 Cor., xii : 8-9. At the base 
of the window is the dedicatory inscription : 
"In Loving Memory of Charles G. W. Macgill. 
Born May 10th, 1833. Died April 28th, 1907." 



At the coming meeting of the American 
Medical Association Dr. Henry D. Fry, of 
Washington, will read a paper on "An Ovarian 
Abscess Containing a Lunbricoid Worm With- 
in the Cavity;" H. D. Hynson, Phar. D., "The 
National Formulary : Its Genesis, Character 
and Exigent Utility." 



Dr. W. L. Hart, class of 1906, first lieuten- 
ant, United States Army, has been ordered to 
accompany Company G, Engineers, to San 
Francisco, Cal., and then to return to Wash- 
ington Barracks, D. C. 



The following physicians have consented to 
act as admitting physicians, Maryland State 
Sanatorium : Dr. Gordon Wilson, Baltimore ; 
Dr. Charles H. Conley, Adamstown. Dr. Guy 
Steele, Cambridge ; Dr. Paul Jones, Snow Hill ; 
Dr. Henry Fitzhugh, Westminster. Drs. Guy 
Steele and C. II. Conley are members of the 
Board of Managers. 



THE HOSPITAL BULLETIN 



51 



Dr. A. M. Shipley, class of 1902, has been 
elected consulting surgeon to the Sydenham 
Infectious Hospital, and Dr. H. O. Reik, of 506 
Cathedral street, consulting otologists. 



Dr. H. E. Palmer, of Tallahassee, has been 
elected president of the Florida State Medical 
Association for the ensuing year. 



The marriage of Miss Elizabeth P. Elliott, 
daughter of Mrs. Warren G. Elliott, to Dr. 
Gordon Wilson, associate professor of medi- 
cine in the University of Maryland, will take 
place on Saturday, June 5, 1909. The cere- 
mony will be performed at 6 o'clock at Old St. 
Paul's Protestant Episcopal Church, Charles 
and Saratoga streets, by the rector, Rev. Ar- 
thur B. Kinsolving. Owing to mourning in 
the bride's family, the marriage will be a quiet 
affair. 



Another wedding of interest to take place in 
June is that of Miss Lila Holmes Trenholm, 
daughter of Mr. Glover Holmes Trenholm, a 
graduate of the Training School for Nurses of 
the University Hospital, and granddaughter of 
the late Prof. Julian Chisholm, to Dr. Walton 
A. Hopkins, class of 1903, of Annapolis, Md. 



At the annual meeting of the Cecil County 
Medical Society, held in Elkton, Md.. April 29, 
1909, Dr. C. P. Carrico, of Cherry Hill, was 
elected president for the ensuing year. 



Dr. George H. Steuart, 
cated at Ottoman, Ya. 



)f 1898, is 



Prof. Samuel C. Chew, the nestor of the 
Medical Faculty of the University of Mary- 
land, is confined to the University Hospital 
with a bad attack of grip. Dr. Chew is one of 
the oldest and most beloved of the medical 
fraternity of Baltimore. He has been con- 
nected with the University of Maryland for 
more than fifty years, graduating with the 
class of 1858. All of us wish Dr. Chew a rapid 
restoration to his former good health. 



Forty professional men were present May 1, 
1909, at the Colonial Hotel, where the fourth 
annual reunion and banquet of the Pennsyl- 
vania Branch of the General Alumni Associa- 
tion of the University of Maryland was held. 
Dr. Eugene F. Cordell was one of the guests ; 
others were Dr. Charles P. Noble, president 
of the Pennsylvania Branch, and Dr. J. C. 
Beale, secretary and treasurer, both of Phila- 
delphia. 

The banquet was held in the new assembly 
room, which was tastefully decorated with 
plants, flowers and the colors of the Univer- 
sity. The banquet committee consisted of Drs. 
Z. C. Myers and S. K. Pfaltzgraff, of York ; J. 
S. Classen and J. C. Beale, of Philadelphia. 



It is reported that Dr. John Cox Keaton, 
class of 1907, of Georgia, has been shot in the 
abdomen by an irate husband. 



At the annual meeting of the Cecil County 
Medical Society, held at Elkton, Dr. St. Clair 
Spruill spoke on '"Surgical Conditions of the 
Right Side of the Abdomen." 



The New York Medical Journal says con- 
cerning the April 13th meeting of the Philadel- 
phia Pediatric Society : "The paper of the even- 
ing was read by Dr. Compton Riely, of Balti- 
more, on 'The Early Diagnosis and Treatment 
of Pott's Disease.' " 



The following of our alumni are upon the 
staff of the Hospital for the Women of Mary- 
land, John street and Lafayette avenue, Balti- 
more : Dr. Charles H. Riley, Dr. J. Mason 
Hundley, Dr. Archibald C. Harrison, Dr. 
Robert T. Wilson, Dr. Samuel T. Earle and 
Dr. George W. Dobbin. Dr. G. W. Billups, 
class of 1906, is resident physicir.n. 



Mr. and Mrs. William T. Schultze, of 822 
Newington avenue. Baltimore, have an- 
announced the engagement of their daughter, 
Dr. Anna D. Schultze, a graduate of the 
Woman's Medical College and resident physi- 
cian of the Good Samaritan Hospital, to Dr. 



52 



THE HOSPITAL BULLETIN 



John R. Abercrombie, dean of the Woman's Dr. Thomas A. R. Keech, class of 1856, and 
.Medical College, a graduate of the University Mrs. Keech. of Washington, D. C, celebrated 
of Maryland of the class of 1895, and at pres- at their home, 416 B street, northeast, on April 
ent instructor in diseases of the skin, Univer- 13, 1909, the fiftieth anniversary of their mar- 
shy of Maryland. No date has been fixed for riage. The house was beautifully decorated 
the wedding. with cut and potted plants. A collation was 

served. The family are of English descent, 

having emigrated and settled in Southern 

At the coming meeting of the American Maryland about 1750. Dr. Keech is a son of 

Medical Association Dr. I. S. Stone, of Wash- the late Rev. John Reeder and Susan P. Keech. 

ington, will read a paper on "Some Minor Gyn- 

ecologic Matters Which Are Often Over- 
looked " Dr. John Herbert Bates, class of 1907, of 

Forest Park, Baltimore, a former resident phy- 
sician of Pay View Hospital, and until recently 
a resident physician at the Church Home and 
Infirmary, has located at 4002 Main avenue, 
Forest I 'ark. 



Dr. Charles H. Medders, of Baltimore, who 
sued the Western Maryland Railroad for 
$5,000 for services rendered in a collision four 
years ago, was rendered a verdict for $150. 



At the animal meeting of the Montgomery 
County Medical .Association, held in Rockville, 
April 20, 1909. the following of our alumni 
were elected to office for the ensuing year: 
Vice president. Dr. Wm. L. Lewis, of Ken- 
sington ; secretary-treasurer, Dr. John L. 
Lewis, of Bethesda. 



Society has 



jllowing offices for 



The Baltimore City Medica 
elected our alumni to the 
the ensuing year: President, Dr. Jacob Hart- 
man ; board of censors, Dr. Randolph Winslow 



The third animal banquet of the General 
Alumni Association of the University of Mary- 
land was held Thursday, April 22, 1909, at the 
Eutaw I louse. Baltimore. About 90 were 
present. The affair was a thoroughly enjoy- 
able occasion, but more enthusiasm would have 
been evident if more of the members of the 
various faculties had been present. The Phar- 
maceutical Department, with less professors 
than the other departments, had most mem- 
bers present. The speeches were witty and in- 
structive, and teemed with expressions of loy- 
alty to the University. As oft iterated and re- 
iterated, this body is the only real live alumni 
body at the University of Maryland. It has 
been, doing since its inception, and is still 
doing, and if the University ever be rejuve- 
nated much of the credit will be due to the 
constant agitation of this body for a larger and 
better university. Most alumni banquets con- 
sist of a feed, good, better or worse, as it might 
happen to be, and a slew of speech artists of 

more or less renown, who bubble over with big 

words of encouragement and prediction, but 
Dr. A. E. Ewens, of Atlantic City, was a rest on their oars here. Indeed, the societies 

member of the Committee on Section Meetings exist for a banquet once a year and a cyclone 

at the recent meeting of the American Medical 

Association. Dr. Daniel Jenifer also had the 

honor and pleasure of serving upon this com- 
mittee. Dr. Jenifer was also a member of the 

Committee on Postoffice and Telephone. Dr. 

A. E. Ewens also served on the Committee on 

Badges. 



Dr. G. Lane Tanevhill, of Baltimore, is a 
member of the House of Delegates of the 
American Medical Association from Maryland 
at the present meeting of the American Medi- 
cal Association, at Atlantic City. 



of hot air. \\ hat do words accomplish? Noth- 
ing. It is action that the University of Mary- 
land needs, and more than anything else men 
of action — strong men, broad-minded men, 
men who can subordinate their success to the 
success of the institution, men in every sense 
of the word. I am glad to say the General 






THE HOSPITAL BULLETIN 



53 



Alumni Association has an abundance of men 
of such character among' its membership who 
are doing something for the good of the Old 
University, and who have an object in view. 
What is this object? The creating of ways 
and means for the betterment of the Univer- 
sity. 

At the business meeting immediately preced- 
ing the banquet the following recommendation 
of the special committee appointed for the pur- 
pose of formulating a plan for the participa- 
tion of the alumni in the management of the 
University was adopted unanimously. 

The plan provides that the Board of Regents 
of the University shall be enlarged by the addi- 
tion of five members, one each from the five de- 
partments, who shall have had their degrees 
for 10 years or more. It provides for the elec- 
tion of a committee on nominations, to consist 
of the president of the association and one rep- 
resentative from each of the five departments. 
This committee shall select three representa- 
tives from each of the five departments as nom- 
inees for the alumni in good standing in the as- 
sociation to vote upon. Votes may be cast in 
person or by mail. After the election of the 
five members of the council they shall deter- 
mine by lot who are to serve for one, two, 
three, four or five years, respectively. 

Any vacancy is to be filled by the remaining 
members of the Alumni Council from the depart- 
ment from which the member was originally 
chosen. The secretary of the General Alumni 
Association shall act as the secretary of the 
alumni regents, who shall select their own chair- 
man for one-year terms. 

The committee consisted of the following 
well-known alumni of the five departments oi 
the University: 

Medical — Dr. 1!. .Merrill Hopkinson and Dr. 
E. F. Cordell. 

Pharmacy — Dr. John F. Hancock and Dr. J. 
Emory Bond. 

Dental — Dr. L. Ii. Farinholt and Dr. Joseph 
C. Heuisler. 

Law — Messrs. B. Howard Haitian and [as. 
YV. Bowers, Jr. 

Academic (St. John's College) — Dr. J. Fred- 
erick Adams and Dr. A. L. "Wilkinson. 

Xo further action, however, can be taken in 
the matter until approved or vetoed by the 
Board of Regents. 



The president. John B. Thomas, Phar. D., 
introduced the toastmaster, Henry P. Hynson, 
I 'bar. I)., who was in a particularly bright and 
witty mood. The speakers were: Hon. J. Barry 
Mahool, the .Mayor of Baltimore; John C. 
Hemmeter, M. D. ; Addison Mullikin, Esq., LL. 
B.; Charles Caspari. Phar. I). : Joshua W. Her- 
ing, M. D., Comptroller of the State of Mary- 
land and a graduate of the class of 1855, of 
Westminster, Md. 

Those who were not present do not know 
what they missed. It was a live banquet, 
something doing every minute, and the com- 
mittee in charge of the arrangements are to be 
congratulated upon the thoroughness with 
which they accomplished their task. 

Committee — T. O. Heatwole, chairman ; Or- 
egon Milton Dennis, LL. B. ; Eugene Hodson, 
Phar. G.; Arthur M. Shipley, M. D. 

Among those present were: William Tarun, 
Dr. J. W. Bird, J. Huff, Dr. Compton Reilly, 
J. Cromwell, Dr. Randolph Winslow, Dr. R. B. 
Hayes, C. V. Mace, L. M. Allen, Dr. R. H. P. 
Bay, Dr. I. J. Spear, H. II. Richards, Dr. J. F. 
Hawkins. Dr. W. V. S. Levy. T. Marshall 
West. S. W. Moore. 1. H. Davis, Dr. C. V. 
Matthews, F. J. Valentine, E. B. Howell, A. P. 
Scarborough, (i. 1'". Dean. <i. A. Hunting, John 
C. Uhler, C. S. Grindall, Dr. J. C. Hemmeter, 
Dr. A. M. Shipley, John Henry Keene. Dr. 
Robert L. Mitchell. Judge 11. Stock-bridge. X. 
II. D. Cox. Dr. J. II. Holland. Dr. Charles 
Caspari, Jr.. II. 1'. Hynson. F. V. Rhodes. J. E. 
Hengst. ( ). C. Harris. A. S. Binswanger, Dr. 
St. Clair Spruill, Dr. I-".. F. Cordell, Dr. Nathan 
Winslow, Dr. J. M. Hundley. Daniel Base. Dr. 
Charles E. Sadtler, Addison Mullikin, II. VV. 
Jones, Dr. G. Lane Taneyhill. Dr. L. B. Ilen- 
kel, Jr., Dr. I. C. Dickson. I". J. S. Gorgas, Dr. 
T. O. Heatwole, J. W. flowers, Jr., Dr. J. W. 
Hering, Alfred E. Kemp, Oscar 1'.. Thomas. 
J. B. Thomas. Eugene W. Hudson. John F. 
Hancock. W. M. Fouch, D. K. Millard, Emory- 
Bond. C. A. Yolkmar. Frank Black. II. P. Hyn- 
son. J. W. Westcott, Dr. C. H.Medders, I'.. El- 
liott. Dr. Eugene Cordell. Leroy Oldham. A. 
R. Dohme, II. A. Lillich, Oregon Milton Den- 
nis. L. W. Farinholt, T. E. Latimer. Ambrose 
Murphy, Dr. Henry Kennard, Dr. Herbert 
Zepp. 



54 



THE HOSPITAL BULLETIN 



The "Clinic," the year book of the College of 
Physicians and Surgeons, Baltimore, which has 
just been issued, is dedicated to the memory 
of the late Dr. Isaac Ridgeway Trimble, who 
gave his life that another's might be saved. Dr. 
Trimble was a graduate of the University of 
Maryland, class of 1884, and at the time of his 
death was Professor of Anatomy in the College 
of Physicians and Surgeons. 



Dr. A. J. Edwards, class of 1898, of Bristol, 
1 enn.j is spending a few days around the 
Hospital renewing old acquaintances. 



Dr. Luther Bare, of Westminster, Md., was 
a recent visitor to the University Hospital. 



The banquet of the Medical Alumni Asso- 
ciation will be held on the evening of May 
31, 1909. 



Dr. and Mrs. B. Merrill Hopkinson, who 
have been spending the week at the Hotel 
Chamberlin, Old Point Comfort, Va., have re- 
turned to the city. 



The University of Maryland baseball team 
defeated the Midshipmen on the Naval Acad- 
emy grounds recently by the score of 2 to o. 
Anderson, the box artist, struck out twenty of 
the middies. The team this year has been 
more than successful, and compares favorably 
with the teams of the larger colleges. It is un- 
doubtedly the premier team of Baltimore this 
year, and in any other institution would arouse 
untold enthusiasm by its notable victories. 



Dr. Fitz Randolph Winslow, class of 1906, of 
Hinton, Va., paid a flying visit to the Hospital 
recently. 



Amongst those who responded to toasts at 
the recent banquet of the local branch of the 
Haverford College Alumni Association was 
Dr. Henry M. Thomas. 



Dr. Fitz Randolph Winslow writes from 
Hinton, Va., in the Valley of the Shenandoah, 
the garden spot of Virginia, and for pic- 
turesque scenery unexcelled in no part of the 
world, that he is doing nicely. He has seen 
three goitres and heard of a wonderful cure for 
the same from an old mountain woman. She 
took her own medicine, and claims to have 
been benefited, so he gives the recipe : Put 
your hands behind your back, bend over and 
take a horse's head between your teeth. Un- 
fortunately, he forgot to find out the statuo quo 
of the horse, so you might try the dead or the 
quick, as suits your convenience. Her goitre 
is still very apparent, but, sad to relate, she has 
no teeth left with which to finish the job. This 
is only one specimen of the gross ignorance 
and superstition of the hill people. They treat 
or mistreat themselves often when ill princi- 
pally by making teas of various herbs, such as 
boneset, etc. Skunk oil is a panacea both in- 
ternally and externally. He expects no re- 
spectable disease can live in the same neigh- 
borhood with such an odoriferous medicament. 



Dr. John Chaplain Travers, class of 1895, of 
Cambridge, who recently left for the Philip- 
pines, where he will enter the govern- 
ment service, gave a farewell entertainment be- 
fore leaving at the residence of Capt. James C. 
Leonard. 



Dr. J. Clement Clark, superintendent of the 
Springfield State Hospital, presided at the 
third meeting of the Maryland Psychiatric So- 
ciety, which was held at the Sykesville institu- 
tion. Among those present were: Drs. J. C. 
Clarke, Marshall L. Price, Wm. F. Wohwartz, 
R. R. Norris, F. J. Flannery. 



Dr. J. W. Hering, class of 1855, of West- It gives us pleasure to announce that Dr. 

minster and State Comptroller, who has been Charles H. Mayo, of Rochester, Minn., one of 

visiting his son and daughter-in-law, Dr. and the renowned Mayo brothers, has accepted the 

Mrs. Joseph T. Hering, at the St. Paul, Balti- invitation of the Faculty of Physic to deliver a 

more, has returned to his home, in Westmin- course of lectures on diseases on the thyroid 

ster. gland in the fall. 



THE HOSPITAL BULLETIN 



oo 



Dr. Lee Cohen, of Baltimore, will read a 
paper at the coming meeting of the American 
Medical Association on "Post Operative Ton- 
sillar Bleeding : Its Surgical Control, with 
Mention of Cases;" Dr. R. L. Randolph, of 
Baltimore, on "Rodent Ulcer of the Cornea ;" 
Dr. Samuel Theobald, of Baltimore, on "Re- 
flex Aural Neurosis Caused by Eye Strain, 
with Report of Cases." 



chair. This is the last meeting of the society 
until the fall. Dr. Woods' paper appears else- 
where in this number. 



One of the marked developments of the 
Democratic State Central Committee was a 
practically unanimous sentiment in favor of 
the renomination of Dr. Joshua W. Hering, 
class of 1855, for State Comptroller. State and 
county leaders were outspoken in their opinion 
that Dr. Hering's popularity throughout the 
state, as well as his excellent record as Comp- 
troller, make his nomination virtually a matter 
of course. 



The condition of Dr. R. A. Warren, of Hot 
Springs, Va., class of 1907. who was operated 
on recently at the University Hospital for ap- 
pendicitis, is reported to be favorable. 



Dr. Randolph Winslow desires to acknowl 
edge cards from Drs. M. Zaki and M. Teufik, 
166 Mohamed Aly street, Cairo, Egypt. These 
are two of our popular Egyptian students, and 
are located as noted above, where they have 
met with unexpected success. Drs. Heilig, 
Moose, Kerr and Pearlstine, four of our recent 
Southern alumni, paid their respects to the 
University recently. The three former are lo- 
cated in North Carolina, the latter in South 
Carolina. 



The last regular meeting of the University 
of Maryland Medical Association was held in 
the amphitheatre of the University Hospital, 
Wednesday, April 21, 1909, and the program 
was as follows: 1. "Preliminary Training 
Necessary for Those Contemplating the Study 
of Medicine." Dr. Randolph Winslow ; 2, "The 
Teaching of Therapeutics," Dr. C. W. Mitch- 
ell; "The Teaching of the Specialties," Dr. Hi- 
ram Woods. 

The meeting was well attended and the 
papers were both instructive and interesting. 
Dr. A. M. Shipley, the president, occupied the 



Dr. Richard H. Johnston, of Baltimore, will 
read a paper on "Benign Tumors of the Turbi- 
nate Bodies Clinically and Pathologically Con- 
sidered," at the coming meeting of the Amer- 
ican Medical Association. 



The Council on Medical Education of the 
American Medical Association in its annual re- 
port has this to say concerning college mer- 
gers : 

Another encouraging fact to be noted is the 
mergers being made among medical schools 
whereby stronger schools are resulting. Not- 
ably in Indiana, all of the regular schools in 
the state merged into the medical department 
of Indiana University, while in Kentucky all 
of the medical schools merged into the Uni- 
versity of Louisville. In Cincinnati the two 
regular schools merged into the University of 
Cincinnati ; in Minnesota Hamline merged into 
the medical department of the University of 
Minnesota. 

There are numerous other cities where mer- 
gers might be brought about if those interested 
in general education and those in medical edu- 
cation in each city would work together to se- 
cure them. For example, if all the medical col- 
leges of any large city, such as Chicago, Phila- 
delphia, St. Louis or others, could be merged 
into one great university medical school, such 
as are to be found in Berlin, Paris or Vienna. 
it would be of the greatest possible advantage 
to medical education in America. 

In the evolution of general and medical ed- 
ucation in this country it is becoming more and 
more evident that a well-rounded university 
needs a strong medical department, and it is 
now equally clear that a medical school cannot 
reach the highest stage of its development ex- 
cept as the medical department of a strong uni- 
versity. It is evident that within a few years 
the medical schools of this country will, with 
few exceptions, be the medical departments of 
universities. Fortunately for the medical 
school, the university needs the medical school 
quite as much as the medical school needs the 
university, so that almost any independent 



56 



THE HOSPITAL BULLETIN 



medical school of real merit can secure desir- 
able union with a university. And this change 
will solve most of our present problems in 
medical education. 

Since our last conference there have been 
five important mergers of medical colleges by 
which nine medical schools are replaced by 
four stronger ones. These mergers were as 
follows : 

1. At Louisville, Ky., the Louisville and 
Hospital Medical College, the Kentucky 
School of Medicine and the University of 
Louisville Medical Department united, retain- 
ing the name of the University of Louisville 
Medical Department. This leaves but one reg- 
ular medical college in Louisville, where there 
were live colleges two years ago. As a direct 
result of this merger, the school has received 
$25,000 from the city of Louisville, and steps 
have been taken to build a new city hospital. 
which is to be largely under the control of the 
medical sch< ml. 

2. At Cincinnati the merger between the 
-Medical College of < 'bin and the Miami Med- 
ical College has been Completed. the new 
school to be the Medical Department of the 
University of Cincinnati. The building of an 
enormous new city hospital has already been 
started near the university campus, and a new- 
medical college building will be erected adjoin- 
ing this hospital. The outlook for this new 
>ehool is very encouraging. 

3. The Keokuk Medical College, College of 
Physicians and Surgeons, located at Keokuk. 
Iowa, has turned all its property and good will 
over to the Drake University, College of Med- 
icine, at Des Moines, Iowa. 

Amalgamation of the Cooper Medical Col- 
lege with Leland Stanford University is an- 
nounced. Henceforth the San Francisco insti- 
tution will be designated the School of Medi- 
cine of Stanford University. The affiliation 
was given approval sometime ago. ami it only 
remained for the board of trustees of the Uni- 
versity to formally accept the gift. 

Why can't the independent medical colleges 



of Baltimore come together? Such an event 
would accrue to the best interests of all con- 
cerned, and would greatly tend to eliminate 
Baltimore as one of the dark spots upon the 
medical educational horizon. 



NURSES WIN DIPLOMAS. 

In spotless white and amid a bower of flowers. 
10 pretty young women were handed their di- 
plomas yesterday as graduates of the Lhiiversity 
Hospital School for Nurses by the Dean, Prof. 
R. Dorsey Coale. There were 17 nurses to grad- 
uate this year, but one of them. Miss Catherine 
M. Dukes, is seriously ill and could not attend. 

After the conferring of degrees Dr. Arthur M. 
Shipley gave the young nurses advice as to their 
future. The opening prayer was delivered by 
Rev. Edwin 1'.. Niver, rector of Christ Protestant 
Episcopal Church, and benediction was pro- 
nounced by Rev. Dr. Hemsley, of Oakland. Md. 

The hall of the University was crowded with 
friends and relatives of the graduates. It was 
decorated with carnations and potted palms, and 
around the pillars was twined black and red bunt- 
ing, the University colors. The nurses, preceded 
by Professor Coale and Dr. Shipley, entered tin.' 
hall in pairs, carrying bouquets of Marguerites. 

Dr. Shipley said that much of the nurses' train- 
ing had been under his supervision, and he felt a 
personal interest in them. Women, he said, in- 
variably scared him, but someone informed the 
physician that was not always so, for Dr. Shipley 
is to become a benedict today. 

"You have chosen a work that is second to 
none in the world." said Dr. Shipley. "You have 
before you possibilities that are almost limitless. 
You are on the threshold of a life that is to be of 
your own making, for the chief danger of the in- 
dividual nurse is drifting. It is so easy to forget 
the old-time standards and call them old-fash- 
ioned. < )ld-fashioned they may be, but they have 
stood the test of generations of correct living and 
thinking." 

At night the graduates were given a farewell 
reception and dance by the undergraduates. 



THE HOSPITAL BULLETIN 



57 



Dispensary Report, April, igc8, to April, 1909. 

OF 

UNIVERSITY HOSPITAL 

Department. New Cases. I H.l Case; 

Surgical 1 .703 4-44 s 

Medical 1.709 3.199 

Genito Urinary 765 2 -933 

Nervous 399 I -'»7 | 

Women 733 '-'79 

Stomach 4-i I.'oS 

Throat and Nose '>->-> 1.039 

Children 7'>r 997 

Eye and Mar 7'^ 9°3 

Skin 473 907 

Tuberculosis 190 703 

( Irthopedic 31 T -° 

8.519 19,609 
Total new cases.. 8,519 
Total old eases. . . . 19.609 

Grand total jN.128 

JOHN HOUFF, M. D., 

Dispensary Physician. 



DISPENSARY PHYSICIANS AND CHIEFS 
OF CLINIC. 

Medical Department — Dr. J. M. Craighill. Chief of 
Clinic; Drs. W. II. Smith. G. C. Lockard, .1. F. 
O'Mara, R. C. Metzel, 11. J. Maldeis, A. B. Hayes, 
II. D. McCarty, E. S. Perkins. J. I'. Adams. II. 1.. 
Sinsky, Clarke. Todd. 

Surgical Department — Dr. John G. Jay, Chi. I ol 
Clinic; Drs. M. T. Cromwell. T. A. Tompkins, Jr., 
J. F. Adams. J. II. Smith. R. I'.. Hayes. 

Stomach Department — Dr R. A. Warner. Chief of 
Clinic; Dr. W. W. Eichenberger. 

Nervous Department — Dr. J. F. Hawkins. Chief; 
Drs. G. M. Settle, F. .1. Wilkins, X. M. Owensby. 

Throat and Nose Department — Dr. II. C. Davis, 
Chief of Clinic; Dr. L. J. Goldbach. 

Eye and Ear Department — Dr. E. E. Gibbons, 
Chief of Clinic; Dr. Win. Tarun. 

Women Department — Dr. Win. I\. White. Chief of 
Clinic; Drs. II. W. Brent, E. S. Perkins, R. L. 
Mitchell. 

Genito Urinary Department — Dr. Wm. D. Scott. 
Jr.. Chief. 

Skin Department — Dr. J. R. Abercrombie, Chief. 

Children's Department — Dr. A. 1!. Lcnnan. Chief; 
Dr. H. Schoenrich. 

Tuberculosis Department — Dr. Gordon Wilson, 
Chief. 

Orthopedic Department — Dr. Compton Riely. 
Chief: Dr. S. Demarco. 

JOHN HOUFF. M. D.. 

Dispensary Physician. 



MARRIAGES. 
Dr. Win. B. Warthen, class of 1905, of Bar- 
tow, Ga., an ex-resident gynecologist j n the 
University Hospital, and one of the most pop- 
ular members of his class, a hale fellow and 
one of the most loyal alumni of the University 
of Maryland, was married at Macon, Ga., April 
15, 1909, to Mrs. Sallie Bell Xewsom, of Davis- 
boro, Ga. The Bulletin and friends of Dr. 
Warthen extend to him their best wishes for a 
long, successful and happy marriage. 



Mrs. Lavinia E. Thomas has issued cards an- 
nouncing the marriage of her daughter, Miss 
Alice Saunders Thomas, to Dr. Edward Bar- 
ney Smith, class of 1907, on April 21st, 1909, at 
Creeds. Virginia. Dr. and Mrs. Smith will be 
at home after May 1, i90<j, at VVoodleigh, X. C. 



The marriage of Miss Helen Ashby, 
daughter of Prof. Thomas A. Ashby and Mrs. 
Ashby. to Mr. Harry J". Giddings, of Baltimore, 
took place April 28, 1909, at the residence of 
her parents, 112=5 Madison avenue, Baltimoie. 



Miss Edna Wright, only daughter of Mr. 
K. J. Wright, a prominent merchant of llur- 
lock, Mel., and Dr. G. Roger Myers, a well- 
known physician of Hurlock, were married 
Wednesday afternoon, April 28, 1909, at the 
home of the groom's parents. Rev. L. F. M. 
Myers, of Philadelphia, a brother of the groom, 
officiated at the ceremony. After a honeymoon 
spent at Atlantic City and other Northern 
points of interest, the couple will make their 
home at 1 1 urli ick. 



Miss Julia C. Cherbonnier, of Baltimore, and 
Dr. Eugene F. Raphel, class of 1906, of Wheel- 
ing, were married at St. Ann's Catholic Church 
March 12. 1909. by Rev. C. F. Thomas, assisted 
by Rev. Win. M. Clements. The bride was 
given in marriage by her father, Capt. A. V. 
Cherbonnier. Her maid of honor was Miss 
Jeannefte Raphel, sister of the groom. The 
groom was attended by his brother, Alexis A. 
Raphel. Among the ushers were Dr. J. Holmes 
Smith, Jr. Dr. and Mrs. Raphel will make their 
home at Wheeling. W. Ya. 



Dr. Arthur Marriott Shipley, class of 1902, 
lor a number of years assistant resident sur- 
geon, ana later superintendent of the I niver- 



58 



THE HOSPITAL BULLETIN 



sity Hospital, now associate professor of sur- 
gery, University of Maryland, was married 
May 6, 1908, at Eutaw Place Baptist Church, 
at 8.30 P. M., to Miss Julia Armistead Joynes, 
daughter of Mr. Tully Armistead Joynes, of 
Baltimore. 



New Mexico, April 13, 1909, from pneumonia, 
aged forty-nine. 



DEATHS. 



Dr. Hugh A. Maughlin, class of 1864, of Bal- 
timore, died Saturday, April 17, 1909, at his 
home, 121 North Broadway, Baltimore. Dr. 
Maughlin was a prominent member of the 
Grand Army of the Republic. Rev. J. Wynne 
Tones, pastor of Abbott Memorial Church, 
Highlandtown, who is the chaplain of Wilson 
Post, of which Dr. Maughlin was a member, 
conducted the funeral services. Burial was in 
Greenmount Cemetery. 



Dr. Newton Clark Stevens, class of 1875, a 
member of the Louisiana State Medical Soci- 
ety, died at his home, in Ama, January 28, 1909, 
agred 62. 



Dr. Howard E. Mitchell, class of 1882, of 
Ellerslie, Md., died at the Western Maryland 
Hospital, Cumberland, Md., April 6, 1909, 48 
hours after having been struck by a train, aged 
fifty-four. 



Recently at Cavite, Philippine Islands, Mrs. 
Mary Gibbs Morris, wife of Dr. Lewis Morris, 
class of 1890, surgeon United States Navy, was 
gathered unto her father. Her husband was 
born in Baltimore, and is the son of the late 
Capt. C. Manigault Morris, commander of the 
Florida, Confederate States Navy. 



Dr. William Hungerford Burr, class of 1884, 
a member of the American Medical Associa- 
tion, for four years surgeon in charge of the 
Santa Fe System Hospital and surgeon to the 
Clark Coal Company, Gallup, New Mexico, 
died in the Santa Fe Hospital, Albuquerque, 



Dr. Edgar T. Duke, one of the most promi- 
nent physicians of Allegany county, died April 
3 at his home, on Bedford street, Cumberland, 
the result of an attack of pneumonia. He was 
43 years old, a son of Major and Mrs. J. E. 
Duke, and was a native of Charlestown, W. 
Va., coming to Cumberland with his parents 
when a young man. He studied pharmacy 
with the late Dr. John F. Zacharias, and later 
read medicine under the late Lr. G. Ellis Por- 
ter at Lonaconing, graduating at the Univer- 
sity of Maryland in the class of 1891. 

Dr. Duke was in love with his profession, 
and was for a number of years secretary of the 
Allegany County Medical Association. He was 
prominent before the association for his special 
papers, and was also prominent on the church 
lecture platform. Hardly a church in Cumber- 
land but that has had Dr. Duke's services. 

He was a member of Chosen Friends' Lodge, 
No. 34, Independent Order of Odd Fellows, of 
which body he was secretary for some years, 
and also a past presiding officer, and was con- 
nected with other fraternal organizations. 

Dr. Duke was also a member of the Ameri- 
can Medical Association, the Medical and Chi- 
rurgical Faculty of Maryland and the Tristate 
Medical Association. He assisted in organiz- 
ing the Western Maryland Hospital Training 
School for Nurses and was one of the lecturers. 
He was an elder and the Sunday school super- 
intendent in the Presbyterian Church. 

He was noted for his kindness. He was also 
active in the Young Men's Christian Associa- 
tion and was chairman of the boys' work com- 
mittee. His father is a prominent Confederate 
veteran. His funeral took place Thursday aft- 
ernoon, April 15, from the First Presbyterian 
Church. At the present time Dr. Duke's aged 
mother is very ill. 

Dr. Duke leaves a widow, formerly Miss 
Gardner; his parents, one brother, Mr. Harry 



THE HOSPITAL BULLETIN 



55» 



K. Duke, and one sister, Mrs. Mary Campbell, 
all of Cumberland. 



Dr. Edward Pontney Irons, an alumnus of 
the University of Maryland, and one of the old- 
est physicians in the city, died Sunday, April 4, 
1909, at the home of his sister, Mrs. William P. 
Lowry, 1023 Harlem avenue. He was 84 years 
old. 

He was born in this city, a son of Dr. James 
and Rebecca Irons, who were of English and 
French-Irish ancestry, and descendants of the 
earlier settlers of the state. He entered busi- 
ness and was variously employed in a number 
of the Southern States. In 1863 he returned to 
this city and entered the University of Mary- 
land. 

After graduation in 1865, when the Civil 
War was nearing its end, he acted as assistant 
surgeon in the Officers' Hospital at Annapolis. 
A year later he went to Alabama, but remained 
only a short time. He returned and opened a 
practice here, which he maintained. 

He retired from active work about seven 
years ago. At that time he was subordinate 
medical examiner for the Royal Arcanum, of 
which he was a member. He was also a mem- 
ber of the Masons, the Baltimore Medical So- 
ciety and the Medical and Chirurgical Faculty 
of Maryland. 

In 1857 he married Miss Anna Rebecca Sew- 
ell, a daughter of Thomas H. Sewell, a Balti- 
more manufacturer. A daughter, Mrs. James 
W. Ramsey, is the only survivor. 



Dr. George C. Farnandas, class of 1852, of 
Baltimore, died Sunday, April 4, 1909, at his 
home, 1721 Maryland avenue, Baltimore, of old 
age. The funeral took place from his late 
home, 1721 Maryland avenue. Dr. Farnandas 
was 80 years old. Before the Civil War he had 
a large practice, but gave it up so that he might 
travel. He was well known to the older gen- 
eration of Baltimoreans. The services were 
conducted by Rev. J. H. Eccleston. rector of 
Emmanuel Church. 

The honorary pallbearers were Dr. N. K. 
Keirle, Dr. James M. Craighill, Dr. Samuel T. 
Earle, Mr. Thomas H. Robinson and Mr. Wm. 
P. Trimble, of Harford county. Burial was in 
Greenmount Cemetery. 



Dr. Benjamin Franklin Laughlin, class of 
1904, died at his home, at Deer Park, Md., aged 
31 years. He first located at Blaine, W. Va., 
where he practiced. He was taken ill at King- 
wood, W. Va., some months ago, and was later 
sent to a Baltimore hospital, but he showed no 
signs of improvement. He was a son of Dr. 
and Mrs. J. W. Laughlin, Deer Park, and a 
brother of Hice Laughlin, a prominent Balti- 
more and Ohio official, Grafton, W. Va. 



Mrs. Virginia Blackwell Carder, aged 38 
years, wife of Dr. George M. Carder, class of 
1891, of Cumberland. Md., died March 17, 1909, 
after a struggle of two weeks against the rav- 
ages of a mastoid abscess. 

Mrs. Carder was preparing to visit her sister, 
Mrs. Gay Breton Leroux, in Douglas, Ga. 

Suddenly she was stricken, and when an op- 
eration became necessary Airs. Carder insisted 
that her husband, a surgeon who has kept con- 
stant vigil the last two weeks, perform the op- 
eration. The operation was apparently very 
successful, and Mrs. Carder was improving, 
when complications in the form of typhoid 
fever set in. Prof. C. W. Mitchell, of Balti- 
more, and Drs. J .T. Walker and Harry Hyland 
Kerr, of Washington, were called by Dr. Car- 
der, and all said everything possible was being 
done for her, but held out no hope. 

Mrs. Carder was the daughter of Thomas 
Callan, of Narrows Park, and, besides her hus- 
band, leaves a little son (Robert Callan Car- 
der), two brothers (George S. Callan, of Duf- 
fields, W. Va., and Charles T. Callan, of Little 
Orleans, Md.), and one sister (Airs. Leroux). 
Miss Mar_\- L. Callan, a sister, was accidentally 
drowned in the Potomac at Little Orleans. 



IN PNEUMONIA the inspired air should be rich in oxygen and com- 
paratively cool, while the surface of the body, especially the thorax, 
should be kept warm, lest, becoming' chilled, the action of the phagocytes 
in their battle with the pneumocoeci be inhibited. 




(Inflammation 's cAntidote) 

applied to the chest wall, front, sides and back, hot and thick, stimulates the 
action of the phagocytes and often turns the scale in favor of recovery. 

Croup. — Instead of depending on an emetic for quick action in 
croup, the physician will do well to apply Antiphlogistine hot and thick from 
ear to ear and down over the interclavicular space. The results of such treat- 
ment are usually prompt and gratifying. 

Antiphlogistine hot and thick is also indicated in Bronchitis and Pleurisy 



The Denver Chemical Mfg. Co. 



New York 




ERTAIN as it is that a single acting cause can bring 
about any one of the several anomalies of menstrua- 
tion, just so certain is it that a single remedial agent 
— if properly administered — can effect the relief of 
anv one of those anomalies. 

<S The singular efficacy of Ergoapiol (Smith) in the 
various menstrual irregularities is manifestly due to its prompt 
and direct analgesic, antispasmodic and tonic action upon the 
entire female reproductive system. 

(§ Ergoapiol (Smith) is of special, indeed extraordinary, value in 
such menstrual irregularities as amenorrhea, dysmenorrhea, 
menorrhagia and metrorrhagia. 

^ The creators of the preparation, the Martin H. Smith 
Company, of New York, will send samples and exhaustive 
literature, post paid, to any member of the medical profession. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 

PRICE Sl.OO PER YEAR 



Contributions invited from the Alumni of the University. 
Business Address, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter. 



Vol. V 



BALTIMORE, MD., JUNE 15, 1909 



No. 4 



A CLINICAL STUDY OF ECTOPIC PREG- 
NANCY, WITH A REPORT OF 
FORTY-FIVE CASES. 

By Thomas A. Ashby, M D., 

Professor of Diseases of Women in the Univer- 
sity of Maryland, Baltimore, Md.; Fellow of 
the American Gynecological Society, etc. 

I wish to relate my personal experience with 
ectopic pregnancy in order to show from a study 
of 45 patients operated on some points of interest 
in the clinical history, diagnosis and treatment of 
this condition. The number of cases coming 
under the observation of a single operator is suf- 
ficient evidence of the frequency of the condition. 
I wish to show from a study of my own cases 
that the clinical history of ectopic pregnancy pre- 
sents a strong argument in favor of the import- 
ance of prompt diagnosis and radical treatment 
ofa dangerous pathologic condition. Whatever 
view we may take of the etiology of ectopic preg- 
nancy, one important fact is shown in the danger 
which attends the condition. Whilst a failure to 
interpret symptoms and delay in diagnosis and 
treatment often lead to unfortunate results, it will 
be shown in this series of cases that the diagnosis 
is not usually made until the patient has reached 
the operating table, and that the surgeon at times 
is dealing with results of long standing, and in 
other cases of immediate importance. 

My first patient was operated on in June, 1889, 
my last in May, 1909. Of the 45 patients, 44 re- 
covered and one died. 

Case I. — Mrs. D., age 25 years, married five 
years, and mother of one child, age four years, 
was referred to me by her family physician, the 
late Dr. George R. Graham, of Baltimore. Men- 
struation was suppressed two months. No other 
symptoms of pregnancy were present. About the 
tenth week after her menstruation had ceased she 
was seized with violent pain in the left ovarian 
region. Dr. Graham was called in, and upon ex- 
amination detected a small movable tumor to the 
left of the uterus and very low in the pelvis. He 



suspected a tubal pregnancy and put the patient 
to bed. Four weeks later the patient was again 
seized with violent pain in the same region, fol- 
lowed by a slight collapse and shock. Upon ex- 
amination Dr. Graham found that the tumor had 
disappeared. On the following morning menstru- 
ation reappeared, but the pain continued. Rup- 
tured tubal pregnancy was strongly suspected. I 
saw the patient in consultation the following day. 
An examination was made under anesthesia, but 
no satisfactory condition could be made out be- 
yond some slight indication of a small movable 
tumor to the left of the uterus high up in the pel- 
vis. After a few days the patient was able to re- 
sume her domestic duties. She was free from 
pain from April 10, the date of consultation, until 
the first week in June, when violent pains re- 
turned in the same region. This continued until 
June 10, when I again saw her in consultation. 
At this time a small but movable mass was felt in 
the left pelvic region. As the patient was in great 
distress, an operation was proposed and accepted. 
On June 11 a celiotomy was done at the patient's 
home and the tumor was removed. It proved to 
be the left ovary containing a small blood clot 
partially ruptured into the folds of the left broad 
ligament. The patient made a prompt recovery. 

The pathologic report proved to be most inter- 
esting. The specimen was examined for me by 
Dr. W. H. Welch, of the Johns Hopkins Medical 
School, who found that it was composed of the 
lateral extremity of the Fallopian tube, the ovary, 
a sac containing blood coagula and fetal mem- 
branes, and a unilocular cyst with the correspond- 
ing part of the ligamentum latum. Dr. Welch's 
report says : ''There is no doubt that the case is 
one of ovarian fetation. It is not possible to ex- 
clude positively the participation of the wall of 
the tube in the formation of the sac containing 
fetal remnants, so that the case may be possibly 
a tubo-ovarian pregnancy." 

The occurrence of ovarian pregnancy has been 
denied by the majority of observers on the 
ground of the physical impossibility of the im- 



62 



THE HOSPITAL BULLETIN 



pregnated ovum being surrounded by ovarian 
tissue. The few cases reported can hardly be con- 
sidered as positively proven, and probably should 
be regarded as belonging to the tubo-ovarian va- 
riety, as shown in the case here reported. This 
variety must of necessity be very rare. An early 
termination of gestation is invited by the physical 
conditions which surround the impregnated 
ovum. Danger from rupture of the sac and hem- 
orrhage should be less than in any other variety. 

Case II. — This patient was seen in consulta- 
tion with Dr. Arthur Williams, of Elk Ridge, 
Aid. Mrs. M., aged 30 years, was seized with 
violent pains in the pelvis, followed by symptoms 
of collapse. She had the usual signs of preg- 
nancy advanced to the eighth or ninth week. Dr. 
Williams was called in. and after examination 
diagnosed the case as one of ruptured tubal preg- 
nancy. I was invited to see the patient in consul- 
tation, and confirmed the diagnosis. The patient 
was advised to go to the Maryland General Hos- 
pital for immediate operation. Owing to her con- 
dition and to unavoidable delay in moving her 
from her home in the country, the operation 
could not be done for some five days after the 
rupture. In the meantime symptoms of infection 
had supervened and the general condition of the 
patient was much depressed. When the section 
was made a large hematocele filled the pelvis ; the 
left tube had ruptured and contained placental 
debris. The blood and placenta were macerated 
and semi-decomposed ; peritonitis, both local and 
general, had started up. The pelvis was emptied 
of blood clots and cleaned as thoroughly as pos- 
sible by removing the damaged tube and other in- 
fected tissue. The operation presented a number 
of difficulties, owing to the extent of the hemato- 
cele and inflammation of the peritoneum, which 
had given rise to adhesioAs and inflation of the 
intestines. 

The patient came out of the operation with 
great shock from the' previous loss of blood and 
from the extent of the procedure instituted for 
her relief. Her pulse at the time of the operation 
was 135 and temperature I02°E. Rally from 
shock was slow. General peritonitis was well es- 
tablished on the fourth day, the abdomen was 
greatly distended, nausea was extreme, and 
bowels were confined. The patient was so ill that 
her life was despaired of. I decided that the only 
measure that could save her was free purgation. 
I gave her one grain (0.06 gram.) of calomel 
everv hour for thirteen hours. At the end of that 



time her bowels began to move and she purged 
copiously until it became necessary to use restora- 
tives. The free purgation soon relieved all of 
her symptoms, and she began at once to make 
rapid progress toward recovery. 

This experience confirmed my faith in the 
value of calomel after abdominal operations, and 
from that time to the present T have found it the 
most reliable of all drugs in post-operative cases 
when free purgation is required. It has one great 
advantage in the fact that it is not given in bulk- 
ami is not easily rejected by the stomach. It is 
seldom necessary to give more than one to three 
grains, in quarter, half or one-grain doses, at in- 
tervals of one hour, to bring on a free bowel 
movement. In this connection I may mention the 
value of salicylate of eserine in one-fortieth of a 
grain (0.0015 gram 1 doses given hypodermically 
in cases of apparent bowel obstruction following 
abdominal operations. Several recent experiences 
have showed the marked efficacy of this new rem- 
edy, and have demonstrated the rapidity of its 
action. During May. 1905. after an operation for 
the removal of an ovarian cyst, the patient's 
bowels refused to move, and symptoms of ob- 
struction were so marked that a reopening of the 
abdomen was seriously considered. All other 
agents had failed, whereupon I gave the patient a 
hypodermic injection of one-fortieth of a grain 
of eserine salicylate. In less than thirty minutes 
a free bowel movement was brought on and all 
symptoms of obstruction disappeared. No un- 
pleasant effects followed the use of the drug, and 
subsequent experiences have shown its great 
value in similar conditions. 

There is no more important condition in the 
after-treatment of abdominal operations than in- 
testinal torpidity. This condition should be 
watched from the very beginning, and should be 
relieved at once if a speedy convalescence is de- 
sired. I make it a rule to empty the intestines 
freely before every operation requiring anes- 
thesia. This may obviate the necessity for an 
early bowel movement after the operation, but it 
does not do away with a careful oversight of the 
intestinal condition which may call for the early 
and free use of purgation. Observation will 
show that in the vast majority of operative cases, 
when the bowels and kidneys are acting well 
a speedy convalescence may be expected. 

Case III. — Presents no important clinical 
symptoms. 

Case IV. — Was a widow of some two years 



THE HOSPITAL BULLETIN 



63 



standing. 30 years of age, and had not borne a 
child. Pregnancy was not suspected. When I 
was called to see her I found her critically ill with 
sepsis. Her pelvis was filled with a large mass 
which I assumed was a pus accumulation. An im- 
mediate operation was advised, but over twenty- 
four hours' delay occurred in getting the consent 
of her friends and in removing her to the hos- 
pital where the operation could be done. The 
patient's condition grew alarming in this interim. 
When the section was made a large encysted he- 
matocele, with ruptured tube containing placental 
debris, at once explained the etiology of the in- 
flammatory condition and the origin of the sys- 
temic infection. General peritonitis and sepsis 
were well under way when the abdomen was 
opened. The intrapelvic condition was removed 
as thoroughly as possible, but it was too late to 
arrest the blood infection, which destroyed her 
life on the fourth day after the operation. The 
social position of this patient misled her physician 
in arriving at a prompt diagnosis in the early 
stage of the attack. The rupture of the tube and 
the hematocele most probably took place a few 
days before he was called in. He had no way of 
knowing the etiology of her condition, and was 
forced to treat it as an ordinary intrapelvic inflam- 
mation. The patient found it necessary to con- 
ceal her true condition from her friends and from 
her physician, and it was not discovered until she 
was on the operating table. Her friends have no 
knowledge of the primary cause of her death. 

Casks Y. and VI. — Presented the ordinary 
physical signs of intrapelvic hematocele, and 
when the abdomen was opened the origin of the 
hematocele was found in a ruptured tube with the 
usual changes indicating the beginning of tubal 
gestation. Rupture occurred in the early weeks 
of gestation, and the remnants of fetal life had 
disappeared with the exception of the placental 
debris. Both patients made uneventful recov- 
eries. 

Case VII. — Presented the history of pregnancy 
advanced to the twelfth week. Symptoms of pri- 
mary rupture were not present, but the physical 
signs pointed to tubal gestation. A positive diag- 
nosis was made and the abdomen opened in an- 
ticipation of a possible rupture at any moment. 
The left tube was removed, being enlarged and 
distended with the placenta and embryo advanced 
to the third month of development. The tube 
wall was so thin from distension that in the ma- 
nipulations connected with its removal it rup- 



tured and expelled a living fetus. Primary rup- 
ture would undoubtedly have occurred within a 
few days had not the section been made. A 
prompt diagnosis and removal of the tube prior 
to rupture made the operation a very simple pro- 
cedure, and the recovery of the patient brought a 
prompt conclusion to her invalidism. 

Case VIII.. — Presents no unusual clinical 
symptoms. This case was the only one in this 
series of 45 cases treated by the vaginal route. 

Case IX. — The diagnosis of pregnancy was 
not positive. The physical signs were those of a 
large intrapelvic tumor most probably of fetal or- 
igin. L'pon abdominal section a ruptured tube 
was found with a ten weeks' fetus, covered up in 
the debris. The case presented no history of rup- 
ture, such as pain, collapse or shock. The leakage 
from the ruptured tube was small and indications 
of absorption of the blood clot were quite mani- 
fest. It is probable that a long delay in operat- 
ing would have led to an almost total removal of 
the blood, and to an encysted condition of the 
fetus, as no evidences of infection were present. 
With the removal of the tube and debris the 
patient made a prompt recovery. 

This case illustrates the probable behavior of a 
class of cases in which nature is successful in re- 
moving the debris of a tubal rupture and in dis- 
posing of the fetus through either gradual ab- 
sorption or by enclosing it in a distinct sac, where 
it may remain buried in the tissues for years. In 
Case XVIII. of this series there is a history of 
this condition in which the fetal bones finally 
worked through the wall of the abdomen and led 
to an infection of the sinus leading down to the 
bed in which the fetal remnants were encysted. 
It is interesting to observe how nature attempts 
to deal with these foreign bodies, and with what 
success when infection is not present. The early 
rupture of the tube may no doubt take place in 
many cases with complete recovery and final dis- 
appearance of the products of conception, and in 
this manner explain how it is that pelvic hem- 
atoceles often go on to complete absorption and 
disappearance. 

Case X. — This patient presents no important 
points for study. 

Case XI. — Upon examination a tumor the size 
of a baseball was found in the left ovarian region. 
She presented a history of pregnancy of some 
eight weeks' duration. The diagnosis of tubal 
pregnancy was made and she was advised to go to 
the hospital for immediate operation, as symp- 



64 



THE HOSPITAL BULLETIN 



toms of rupture were indicated by colicky pains 
simulating those of uterine colic. She was ad- 
mitted to the hospital late at night and was pre- 
pared for an early operation. When the abdomen 
was opened at 10.30 o'clock the next morning the 
tube was found ruptured and a small fetus of not 
over seven or eight weeks' development was 
found half-way expelled through a rupture in the 
tube which probably occurred only an hour or 
two before operation. A small vessel at the seat 
of the rupture was discharging arterial blood into 
the abdominal cavity, which contained some ten 
or twelve ounces. The patient had already be- 
come blanched and weak from loss of blood from 
the upper surface of the tube, the most dangerous 
point where rupture could occur. A ligature was 
thrown around the tube close to the uterus and 
the tumor mass removed. But for the prompt- 
ness of the operation this patient would have per- 
ished from a concealed hemorrhage. 

The case demonstrates one of the great dangers 
of primary rupture with leakage into the general 
abdominal cavity, and the treacherous nature of 
tubal gestation. In the absence of an abdominal 
section primary rupture of the tube cannot be 
considered otherwise than hazardous, since in the 
absence of operation the physician in attendance 
can form no opinion as to the location of the rup- 
ture and possible limit of hemorrhage. The 
symptoms of collapse and shock may give some 
indication of the necessity f®r immediate action, 
but these symptoms are not reliable and can sel- 
dom be trusted. A secondary rupture usually in- 
dicates an encysted form of hematocele — by far 
the most common form of tubal leakage, as is 
shown by this series of cases. It is probable that 
the primary rupture into the general abdominal 
cavity leads to death in the larger number of cases 
before the symptoms of pregnancy are observed, 
and in this way we may account for the sudden 
deaths which are now and then observed from 
concealed hemorrhage, and in which an autopsy 
is not made to clear up the cause of death. 

This case teaches the important lesson that tu- 
bal gestation is not an innocent condition, and 
that when the condition is recognized before rup- 
ture has taken place an immediate operation 
should be done to remove the treacherous tube. 
No confidence can be placed in nature's method 
of dealing with ectopic gestation, either before or 
after rupture has occurred. The fact that we find 
in intra-abdominal work such a large number of 
old hematoceles of tubal origin, showing a partial 



escape from the consequences of rupture and 
leakage, cannot be used as an argument in sup- 
port of delay when a diagnosis of ectopic preg- 
nancy has been made. An immediate explora- 
tory section to establish a diagnosis in a suspected 
case would be less hazardous than the expectant 
line of treatment. 

Case XII. — This patient presented the usual 
symptoms of pregnancy — suppression of men- 
struation, enlargement of the breasts, morning 
sickness, and slight increase in the size of the 
uterus. Upon examining her pelvis a large tu- 
mor, presenting the signs of an enlarged tube, 
was found in the left pelvic region. The diag- 
nosis of left tubal gestation was made. No indi- 
cations of a threatened tubal rupture were pres- 
ent, but it was decided to operate at once and 
forestall such an occurrence. Upon opening the 
abdomen in the median line the tumor was easily 
reached and drawn out through the incision. In 
the manipulation attending the withdrawal of the 
tube it ruptured and a small living fetus was ex- 
pelled. The tube was tied off close to the uterus 
and removed. The operation required only a few 
minutes and was attended with but little loss of 
blood. The recovery of the patient was une- 
ventful. 

Cases XIII. and XIV. — Present no unusual 
clinical features. 

Case XV. — Mrs. M., the mother of four chil- 
dren, presented all the rational signs of preg- 
nancy. Nausea and vomiting were incessant and 
continued for several weeks, until emaciation and 
depression were extreme. An examination of the 
pelvis was then made to determine the condition 
of the uterus, but nothing satisfactory was re- 
vealed. At this time the gestation was believed 
to be normal. During the third week the nausea 
suddenly ceased and the patient began to take 
nourishment. The patient then had a rise of tem- 
perature, followed by symptoms of intrapelvic in- 
flammation. There were no symptoms of tubal 
rupture, but the sudden arrest of nausea, and de- 
velopment of intrapelvic inflammation, led to the 
opinion that the gestation had been arrested and 
its tubal origin was strongly suspected. This 
led to a careful examination under anesthesia, 
when a small mass in the left ovarian region 
was discovered. The uterus was only slightly 
increased in size. Tubal pregnancy was so 
strongly suspected that it was decided to open 
the abdomen on the following day. When the 
section was made the left tube was found en- 



THE HOSPITAL BULLETIN 



65 



larged to the size of a hen's egg. In the canal 
of the tube was a small gestation sac unrup- 
tured, but containing only placental tissue. 
Fetal death had occurred so early that its ab- 
sorption was complete. A mild infection had 
begun in the tube, and this no doubt had caused 
the rise of temperature. With the removal of 
the tube the patient was soon restored to 
health. 

In this patient there was an unusual disturb- 
ance of her digestive organs following concep- 
tion, but this subsided with the death of the 
embryo. But for an infection of the tube con- 
taining the fetal remains a complete subsidence 
of the trouble would probably have taken place. 
It is interesting to inquire whether an infection 
of the tube brought about an arrest of the ges- 
tation or followed in the wake of the embryo's 
death? Could this question be answered in the 
affirmative it might explain how the death of 
the embryo is brought about in the first few 
weeks of gestation in certain cases. 

Case XVI.— -Mrs. B., a multipara, age 35 
years, was admitted to the University Hospital 
from North Carolina. At the time of her ad- 
mission she was critically ill with an acute in- 
trapelvic inflammation, the origin of which 
could not be explained by her history. A large 
mass filled the pelvis and presented all the 
physical signs of an acute salpingitis. An ab- 
dominal section was made as soon as the 
patient could be prepared for the operation. 
The mass was found to be a large encysted 
hematocele, due to a ruptured tube, induced by 
the overdistension of placental tissue and blood 
clots. Infection had taken place and the pelvic 
cavity and contents were actively inflamed. The 
entire mass was removed and the abdomen 
closed. The subsequent condition of the patient 
was satisfactory until the tenth day, when her 
temperature began to go up and down in an er- 
ratic way. An examination of the pelvis and 
of the abdominal wound showed complete re- 
pair and not the slightest signs of infection. 
Finding in her surgical condition no explanation 
for the temperature changes, I suspected a ty- 
phoid infection, and blood examinations re- 
vealed a typical Widal reaction. For the fol- 
lowing fifteen weeks the patient ran the course 
of typhoid fever, and, though much reduced 
physically, eventually recovered. I am unable 
to explain the occurrence of the typhoid infec- 
tion in connection with a tubal gestation except 



upon the theory that the tubal condition was 
of long standing and the typhoid infection had 
rekindled a tubal inflammation, which at once 
called attention to the intrapelvic condition for 
which the section was done. The removal of 
the tubal condition had little influence over the 
typhoid infection, which ran a typical course. 
But for the removal of the diseased tube I be- 
lieve the patient would have lost her life. 

Case XVII. — This patient, a colored woman, 
about 35 years of age, was admitted to the Uni- 
versity Hospital to be treated for a large intra- 
abdominal tumor which was solid in character 
and freely movable. It was attached to the 
uterus by a long pedicle, and in its physical as- 
pects seemed to be a solid tumor of the ovary, 
or a subperitoneal fibroid with an elongated 
pedicle. There was no history of pregnancy 
and this condition was not considered. When 
the abdomen was opened the true character of 
the tumor was made out. It was found to be a 
greatly enlarged left tube with the fetus partly 
expelled from the fimbriated end. The tube 
was attached to the uterus by a pedicle over six 
inches in length, the whole mass being so freely 
movable that it was easily withdrawn through 
the abdominal incision and detached from the 
uterus. The operation for its removal took 
only a few minutes. 

This pathological finding is the most interest- 
ing of this series of cases, since it explains the 
manner in which tubal abortions take place and 
how the tubal variety is converted into the ab- 
dominal variety. The body of a dead fetus was 
enclosed in the cavity of a large tube, whilst 
the head of the fetus, covered with the amnion, 
has been expelled, the neck being tightly 
grasped by the open end of the tube. Before 
the fetus perished the tube had attempted to 
expel it into the abdominal cavity, and had its 
expulsion been complete, and the fetus still 
viable, the development continuing, the abdom- 
inal variety of pregnancy would have resulted. 
As it happened, the fetus probably perished be- 
fore its complete expulsion was accomplished, 
and the expulsive power of the tube was so 
weakened by the arrest of fetal growth that it 
remained in the condition in which it was found 
at the time the abdomen was opened. Just how 
long the patient had carried this dead fetus I 
was unable to determine, but from her some- 
what indefinite statement as to the presence of 
the tumor I am led to believe that more than 



66 



THE HOSPITAL BULLETIN 



six months had intervened from the time she 
first observed it to the time of the operation. 
Fortunately, the fetus was so hermetically 
sealed up in the abdomen that infection did not 
take place, and there was no evidence of ab- 
sorption. It was dead, but well preserved. 
There had been some slight escape of blood 
into the abdomen — shown by the discoloration 
of the tissues and a few flakes of lymph scat- 
tered here and there. The freedom with which 
the tumor could be moved was probably due 
to the weight of the mass on the uterine end of 
the tube, which had elongated by traction. 

The origin of the abdominal variety of ectopic 
pregnancy has been so fully establishd that but 
few cases can be referred to any other seat of 
development than the cavity of the tube. This 
case so beautifully shows how the tubal variety 
is converted into the abdominal variety that a 
positive demonstration may be claimed. 

Case XVIII. — This patient was a multipara, 
aged 30 years, admitted to the University Hos- 
pital with a small abscess sinus located in the 
median line midway between the umbilicus and 
the symphysis. There was no history of preg- 
nancy and the condition was not suspected. 
Upon physical examination a small inflamma- 
tory tumor was found in the left pelvic cavity. 
There was some fixation of the uterus. Intro- 
ducing a blunt probe into the sinus, it was 
easily pushed down into the pelvis until it had 
reached the tumor mass. This sinus was found 
acting as a drain canal to the pelvic abscess, 
and had served as a route for the escape of 
small fetal bones which were buried in the 
deeper tissues. An abdominal section was made 
and the debris of a small fetus, chiefly bones, 
was found buried in the wall of the abdomen 
and underlying structures and connected with 
a ruptured tube coming off from the left horn 
of the uterus. 

The explanation of the condition was now 
made plain. This patient without her knowl- 
edge of pregnancy had carried a fetus in the 
left tube between eight and ten weeks. The 
overdistended tube had cast out the fetus and 
it had been walled off from the general abdomi- 
nal cavity by a distinct sac wall, the sac subse- 
quently forming close attachments to the wall 
of the abdomen, through which pus and fetal 
bones finally made an exit. Here was an intel- 
ligent effort upon the part of nature to throw 
off a dead fetus by the abdominal route. This 



is the only instance in this series of cases in 
which an effort was made to eliminate the dead 
fetus in this manner, and I must assume that 
there were physical conditions present which 
made this method possible. After the removal 
of the debris and damaged tube the patient was 
restored to good health. 

Cases XIX. XX., XXI and XXII.— These 
cases were operated on in the University Hos- 
pital during the years 1903 and 1904. As they 
were only diagnosed as ectopic pregnancy 
on the operating table, I shall refer to them 
very briefly. In each case the patient gave no 
history of pregnancy, and there were no symp- 
toms which could explain the etiology of their 
conditions at the time of the operation. In each 
the physical signs indicated chronic tubo-ova- 
rian disease. After an abdominal section was 
made and the tube was exposed to view the 
etiology of the tubal condition was explained. 
In each instance a ruptured tube was found and 
placental remnants were present. Evidences 
of extensive hemorrhage were not found, but 
indications of attempted repair and of chronic 
tissue changes were observed. These cases fol- 
lowing each other so closely present a history 
frequently overlooked in intra-abdominal work 
— a history of minor tubal disease caused by an 
early r arrest of a tubal gestation with an incom- 
plete repair of the damaged organ, followed by 
svmptoms of tubo-ovarian inflammation. 

In dealing with this class of patients it is 
often fair to assume on circumstantial evidence 
much that cannot be definitely proved. These 
women had all been exposed to the contagion 
of gonorrhea, and no doubt had had gonorrheal 
salpingitis of mild degrees. The arrest of an 
infection may limit, but not totally destroy, the 
function of the tube, and thereby favor tubal 
conceptions and abortions. On such an assump- 
tion as this we can explain the frequency of 
tubal conceptions and early ruptures when no 
other explanation seems satisfactory. If such 
an explanation as this is not valid, how are we 
to explain the frequent occurrence of early 
tubal ruptures and hematoceles in this class of 
cases? It is not possible by statistics to prove 
the extent of the etiologic influence of gonor- 
rhea in ectopic pregnancy, but clinical obser- 
vation will show how justly we may suspect 
the preliminary work of the gonoccoccus in this 
sphere of action. 

Case XXIII. — This patient was a young mar- 



THE HOSPITAL BULLETIN 



67 



ried woman admitted to the University Hospital 
with procidentia uteri. She gave no history of 
pregnancy. Upon examination the cervix was 
found external to the vulva, and both external 
os and fourchette gave no evidence of a pre- 
vious pregnancy. To the left of the uterus a 
tumor the size of a base ball could be made out. 
It presented the physical signs of a small ovarian 
cyst. When the uterus was pushed up in the 
pelvis the tumor was movable with it. The diag- 
nosis of ectopic pregnancy was not made until 
the abdomen was opened and the tumor re- 
moved. Upon examination the specimen was 
found to be a distended tube contain- 
ing placental debris and coagulated blood. 
Tubal rupture had not taken place, as gestation 
had been arrested at a very early stage of de- 
velopment and the contents of the tube had not 
exercised sufficient pressure to break through 
its distended walls. 

This was clearly a case of arrested gestation 
without expulsion of the embryo, and well ex- 
plains how the death of the embryo may occur 
without serious danger to the patient. A fall, 
blow or misstep would have been sufficient in 
this case to cause a rupture of the tube without 
subjecting the patient to any graver condition 
than a small hematocele. May not many of the 
pelvic hematoceles be accounted for in this 
way? It is only by a study of the pathology- of 
the tube found after operation that we are able 
to arrive at a correct understanding of the con- 
ditions presented. The early death of the fetus 
in ectopic pregnancy is the most fortunate dis- 
position which nature can make to correct a 
false step in gestation. 

In the case under consideration, the patient 
had not skipped her menstruation and had 
neither morning sickness nor enlargement of 
the breasts. But for the pathologic finding 
pregnancy would not have been discovered. 

Case XXIV. — Mrs. A., age 39 years, the 
mother of one child, nine years of age, was ad- 
mitted to the University Hospital in April, 
J905, with a history of ectopic pregnancy. Upon 
examination the entire pelvis was found filled 
with a doughy mass, which w r as recognized as 
an extensive hematocele from a tubal rupture 
of some days' standing. The blood as it leaked 
from the ruptured tube had dissected its way 
through channels made in the loose connective 
tissues of the pelvis, and had formed a dense 
coagulum, which enveloped the uterus, tubes 



and ovaries with one large mass of blood and 
fibrin. In removing the mass I found it neces- 
sary to remove both tubes and ovaries, and to 
do a supravaginal hysterectomy. After clean- 
ing out the pelvis and abdomen I found so 
many small lymph deposits and uncovered 
spaces on the bladder, rectum and small intes- 
tines that I was apprehensive that a post-opera- 
tive infection would give trouble. A puncture 
was made in Douglas' cul-de-sac into the vagi- 
na and a gauze drain was established through 
this route to provide for the escape of material 
the peritoneum might not be able to take care 
of. The abdomen was closed. During conval- 
escence drainage was very considerable, and no 
doubt contributed to the early convalescence of 
the patient. 

The question of vaginal drainage in this class 
of cases is very important, and whilst it may 
not always mean the difference between life 
and death, it may materially- influence conval- 
escence and post-operative symptoms. When 
there is an assurance that the peritoneum can 
deal with leakage and debris unavoidably left 
after an extensive intrapelvic operation, drain- 
age by either route is unnecessary, but when 
this assurance is involved in grave doubt it will 
depend upon the judgment of the . operator 
whether he shall drain primarily or wait for 
positive indications during the post-operative 
period. Men of experience will always differ 
in answering this question. The only answer 
one can give is based upon one's instincts. 
There is a monitor which seems to suggest a 
proper line of action in the majority of in- 
stances and the man who exercises judgment is 
less likely to fail than one who is biased in favor 
of or against a given procedure. The indica- 
tions for abdominal drainage should be so pro- 
nounced that it is accepted or rejected at once. 
Vaginal drainage, on the contrary, imposes no 
severe discomfort upon the patient, and the 
opening may- be closed in a few days without 
difficulty. It provides for a concealed leakage 
and keeps the operator in closer touch with in- 
trapelvic conditions. 

The drain-canal should be accommodated to 
the condition calling for its use. 

In large areas of leaky surfaces considerable 
packing should be done. In other cases a lamp- 
wick-drain may be sufficiently large to control 
the conditions left within the pelvis and to pro- 
vide an outflow that would occasion trouble if 



68 



THE HOSPITAL BULLETIN 



left to seek its own outlet. Convalescence may 
be hastened by a properly used vaginal drain 
or retarded by trusting too much to nature's 
methods of removing exudates. 

Case XXVII. — Mrs. M., multipara, youngest 
child 15 years of age, had married her second 
husband four years ago. She had missed two 
menstrual periods. She had all the usual signs 
of pregnancy. For several days she had suf- 
fered with colicky pains in her pelvis, but at- 
tached no importance to them. At 3 P. M. of 
November 7, 1905, she was seized with violent 
pains, followed by shock and collapse. Dr. La 
Bara, her physician, was hastily called in, and 
upon examination diagnosed a ruptured tubal 
pregnancy with concealed hemorrhage. He had 
the patient conveyed to the University Hos- 
pital as soon as the ambulance could be ob- 
tained. She reached the hospital between 5 
and 6 o'clock in a profoundly collapsed condi- 
tion, with a pulse weak, thready and over 150 
per minute, respiration quick and shallow and 
hemoglobin under 50 per cent. It was neces- 
sarv to give normal salt injections and strych- 
nin to keep up the flagging circulation. I 
reached the hospital at 7 o'clock and an abdom- 
inal section was imperative at once. The 
blanched and collapsed condition of the patient 
gave little encouragement. Upon opening the 
abdomen over one quart of fresh arterial blood 
was found in the pelvis and among the intes- 
tines. The tubes were hurriedly sought for 
and the left tube was found ruptured from over- 
distension on its upper border and still leaking 
at the site of rupture. It was tied off promptly 
and hemorrhage at once ceased. The intra-ab- 
dominal cavity was thoroughly cleansed and 
then filled with normal salt solution. No fetus 
was found. The patient rallied slowly from the 
operation, and within four weeks' time had re- 
gained her loss of blood. But for the prompt 
abdominal section this patient would have per- 
ished in a few hours. 

Of the following series of cases, Nos. XXVII., 
XLIIL, XLIV. and XLY. are the only ones 
that present unusual clinical features. In the 
cases reported I have given brief descriptions 
of unusual symptoms and conditions which 
serve to illustrate the treacherous behavior of 
tubal gestation. 

It will be observed that the question of diag- 
nosis is the all-important question in dealing 
with the condition. It will also be noticed how 



seldom the diagnosis is made before the patient 
reaches the operating table. I have found that 
over 70 per cent, of the cases operated upon 
were simple pathological finds. The history of 
the case and symptoms presented no positive 
evidence of the condition while the physical 
examination only revealed intrapelvic masses 
of tubal or ovarian origin, showing some path- 
ological condition of these organs necessitating 
an intra-abdominal operation. 

Case XLIII. — ■ This patient's history is 
worthy of record, since it illustrates the ex- 
treme degree of involvement of the intra-pelvic 
space with the debris of an extopic rupture. 
The patient, 35 years of age, was admitted to 
the hospital from Virginia. She was greatly re- 
duced in flesh and was critically ill. Physical 
signs showed a large mass in the pelvis extend- 
ing well above pubic region. Diagnosis of rup- 
tured pregnancy suspected. History of arrested 
gestation of some weeks' standing was the only 
cue to her condition. 

She was so weak and emaciated when put on 
the operating table that strychnia and normal 
salt infusions were given before she was anaes- 
thetized. 

The operation proved to be a very extensive 
one. It became necessary to remove not only 
large masses of clotted blood, with both tubes 
and ovaries, but also to remove the uterus. The 
disorganization of the pelvic connective tissue 
and ragged condition of the surrounding struc- 
tures made it necessary to drain by both vagi- 
nal and abdominal routes. The patient was so 
profoundly shocked by the operation that her 
death on the table was fully expected. When 
placed in bed restoratives were used constantly 
until, after some 36 hours, she began to revive. 
As drainage was free, her convalescence was 
slow and tedious, but her recovery was com- 
plete. 

Case XLIV. — This case presents several unu- 
sual symptoms. Mrs. A., age 39, mother of one 
child, 16 years of age, during a recent visit to 
Europe began to experience unusual pelvic dis- 
comfort. There were no positive signs of preg- 
nancy, but a slight interruption of menstruation 
for several weeks, followed by a continuous dis- 
charge of blood from the uterus, lead to a sus- 
picion of a possible early abortion. During her 
trip across the ocean and for several weeks 
after her return home uterine hemorrhage con- 
tinued more or less freely. Upon examination 



THE HOSPITAL BULLETIN 



69 



a distinct intrapelvic tumor to the left of the 
uterus, and closely attached to it, was easily 
made out. The hardness of the tumor and its 
close attachment to the uterus gave the impres- 
sion that it was a fibroid. An operation was 
advised, and some two weeks later was per- 
formed. The tumor proved to be an enlarged 
tube containing placental debris. The foetus 
had perished early and had been absorbed. The 
uterine hemorrhage was found to be due to the 
overflow of blood from the tube, which was 
leaking through the intra-uterine orifice. This 
leakage of blood had occasioned the menor- 
rhagia, and had also prevented a rupture of the 
tube from overdistension. It fortunately pre- 
vented an intrapelvic hematocele, so often met 
with in these cases. At the time of the opera- 
tion a slight leakage of blood had found its way 
into the pelvic cavity. This patient made an 
early recovery. 

Case XLV. — This, the last case of this series, 
was operated on on May 7 last. In some respects 
it is one of the most instructive of this series. The 
patient was married, 19 years ago, and had 
borne no children. She was admitted to the hos- 
pital on May the 6th in a very critical condition. 
There was no history of pregnancy and the physi- 
cal signs pointed to an inflammatory mass filling 
the pelvis, an acute bilateral salpingitis. The 
patient was running a high temperature with a 
weak and rapid pulse. She was so depressed that 
it was deemed best not to operate until the fol- 
lowing morning. Ice caps were placed over the 
lower abdomen and strychnia and morphia 
were given in full doses. 

When placed on the operating table her condi- 
tion was extremely critical. Stimulants and infu- 
sion of normal salt were given during anaesthesia. 
Physical examination under ether did not clear 
up the doubt as to the character of the intra- 
pelvic mass. When the abdomen was opened 
the condition was manifest. The abdominal 
cavity was filled with masses of dark-colored 
clotted blood. The tube in the left side had 
ruptured from an early pregnancy, whilst the 
right tube was partially disorganized from an 
old salpingitis. I have never met as much free 
flow of blood in an abdominal cavity. It was ap- 
parently of some days' standing, as no leaking 
vessels were found. Before the operation was 
half completed the assistant remarked to me that 
the patient was apparently dying. I replied 
that I would complete the operation whether 



the patient was dead or alive, and as rapidly as 
I could finished the technique of the operation. 
When this was done and the condition of the 
patient was investigated, I agreed with my as- 
sistant that the patient's chances for living 
were poor indeed. Thanks to the patient and 
intelligent work of my assistants, Drs. Brent, 
Hammond and Mackall, the patient began to 
rally, and within 24 hours had fully recovered 
from shock. She then made a very rapid re- 
covery. 

I wish here to offer a few suggestions which 
may be helpful to younger surgeons. I have a 
number of times been told by the assistant that 
the patient was dead or dying on the table, to 
hurry up the operation or to sew up the inci- 
sion before the operation was completed. Ex- 
perience has shown me that it is better judg- 
ment to do a complete operation on a compar- 
atively dying patient than to hurry to close the 
incision and leave behind conditions which will 
surely cause the death of the patient a few 
hours or few days later. I know I have saved 
a number of patients who were apparently dy- 
ing on the table by following this rule. 

It must be borne in mind that apparent shock 
is often due to profound anaesthesia. A broken 
down heart will often recover when the anaes- 
thetic is withdrawn and powerful stimulation 
is used. This little line is worth remembering 
in surgery, as well as in its application to the 
many discouragements of life : 
"Never give up; there are chances and changes 

Helping the hopeful a hundred to' one; 
And through the chaos high heaven arranges 

Ever success if you only hope on." 

Conclusions. — Ectopic pregnancy is a much 
more common cause of intrapelvic disease than 
lias been supposed. 

Rupture of the tube from overdistension is 
the chief cause of intrapelvic hematocele. Pri- 
mary rupture into the folds of the broad liga- 
ment occurs far more frequently than any 
other form of rupture, and is attended with less 
danger to the patient. 

Tubal abortions are infrequent, but the death 
of the fetus at a very early stage of develop- 
ment may result in a hematoma of the tube or 
give rise to a hemato-salpinx, requiring a re- 
moval of the damaged tube. 

Gonorrheal salpingitis is the most frequent 
cause of tubal gestation, and of early death of 
the embryo. 



70 



THE HOSPITAL BULLETIN 



Tubal pregnancy is the common form of ec- 
topic gestation and the primary stage of the 
abdominal variety. 

The tubo-ovarian variety was found in one 
case of this series of 45 cases. 

Ectopic pregnancy is a treacherous condition 
and should be arrested by an abdominal section 
as soon as it is recognized. 



PRESIDENT'S ADDRESS AT THE .MEET- 
ING OF THE MEDICAL ALUMNI 
ASSOCIATION. 
By Thomas M. Chaney, M. D., Chaney, Md. 

To the Alumni Association of the School of Med- 
icine of the University of Maryland: 
I thank you, gentlemen, for the honor you con- 
ferred upon me a year ago in making me Presi- 
dent of this Association. 

Every alumnus of the Medical School of the 
University should be proud of his relation to it. 
Back of him are one hundred years of useful 
work by the alumni of this school, throughout 
the world and especially in this State. 

In my opinion this school has been the most 
useful educational institution that has ever ex- 
isted in this State. It has done more than any 
other for the health, the comfort and well-being 
of the people of this State by sending out men 
equipped to give relief to the sick, men in ad- 
vance of others in their communities in intelli- 
gence and morality, and men who by association 
with professors who had high ideals of their pro- 
fessional duties had gotten the best preparation 
possible for becoming useful and upright citizens. 
There are no educational institutions in the State 
and few in the country that hold such a record 
as does this school. There are older schools in 
the State, but ours is the oldest medical school, 
and I claim that the services of a well prepared, 
conscientious physician are more important in a 
community than those of the best men belonging 
to any other profession. 

For many years being the only medical school 
in the State, it supplied with physicians every 
part of this State and much of Virginia, the Car- 
olinas and other Southern States. This is our 
record. 

Many who attended our school years ago look 
back, and. recalling such names as McSherry, 
Aiken. Miltenberger, Smith, Chew and others, 
speak of that as the golden period of our school. 
A few years ago, while living in the city, I had 
good opportunities for seeing the work in the 



different medical schools and hospitals of the 
city. I became convinced that this school is 
doing better work now than it has ever done at 
any period since I have been familiar with it, and 
that it is doing as good work as any other school 
in the city. As proof of this faith I offer my 
works. Two Chaney boys, a son and a nephew, 
have recently been added to the list of alumni of 
the school, and nearly or quite all persons who 
come from our part of the country to enter a 
hospital come to the University Hospital. In our 
part of the State — Calvert and lower Anne Arun- 
del — physicians who graduated at other schools 
send their patients here. This is the best proof 
of the estimate placed upon the work of the men 
now in charge of the school and the hospital. 

The future of the school is assured. There is 
no reason for alarm. We send no Jack Binns 
to send out C. O. D. messages. But the compe- 
tition between the medical schools of the city is 
greater than ever before. Here and throughout 
the country schools of all kinds are making 
changes with a view to improving their courses 
of study and giving better training to their 
pupils. 

The formation of an advisory council is one 
that has already been started in connection with 
the University of Maryland. Another change 
from Provost to President. University of Vir- 
ginia, Win. Wirt, first elected to Presidency ; 
then Dr. Alderman. But these subjects will be 
discussed by others. The one important ques- 
tion for us tonight is disbandment. However 
this may be, let us keep up our interest and re- 
turn year by year, and as Antaeus become in- 
vincible by touching his mother earth. 



REPORT OF COM MITTEESTOREGENTS 
OF UNIVERSITY OF MARYLAND ( >N 
REORGANIZATION OF UNIVERSITY 
MANAGEMENT, Etc. 
To the Regents: 

At our last meeting two committees were 
appointed, consisting of Professors Hemmeter, 
Poe and Ashby, and Professors Poe, Harlan 
and Coale, to consider a preamble and resolu- 
tion adopted by the General Alumni Associa- 
tion of the University, suggesting the election 
of a paid provost or president, with a govern- 
ing body independent of the teaching bodies, 
and to confer with the General Alumni Asso- 
ciation as to the expediency of the establish- 
ment of an advisory council from amongst the 



THE HOSPITAL BULLETIN 



71 



alumni to communicate with the Regents on 
problems of university administration. 

Inasmuch as these two resolutions, while not 
identical, related to the same matter, the mem- 
bers of these two committees deemed it ex- 
pedient to consider them jointly, with a view 
to the better understanding of the questions re- 
ferred to them. 

Having been formally advised of the appoint- 
ment of a special committee of ten of the Gen- 
eral Alumni Association, with instructions to 
present to the Regents a recommendation from 
the General Alumni Association looking to 
alumni representation in the Board of Regents, 
your committee invited this committee of ten 
to a conference, which was held at the office of 
Professor Poe on the 5th of May, instant. 

At this conference the views of the commit- 
tee of the General Alumni Association were 
presented and discussed; the text of the rec- 
ommendation of the General Alumni Associa- 
tion was laid before your committees, and a 
full statement made of the views and wishes 
of the Alumni Association upon the whole sub- 
ject. 

Your committees have considered with some 
care the matters submitted to them, and the 
arguments of the Special Committee of Ten, 
and now present the conclusions which they 
have reached. 

Upon an examination of the charter of the 
University, as contained in the Act of 181 2, 
Chapter 159. your committees do not find any 
provision under which the recommendation of 
the General Alumni Association for the elec- 
tion from the alumni of five members to the 
Board of Regents could be validly accom- 
plished. 

Regents are authorized, and the mode of 
their appointment prescribed, for the several 
faculties which, by the charter, constitute the 
University, but we find no warrant for the in- 
troduction into the body of Regents of mem- 
bers not representing or professing to repre- 
sent any one of these several faculties. 

When it is borne in mind that of the present 
Board of twenty-three Regents fifteen are 
alumni, who, in their position as regents and as 
alumni, are thoroughlv in touch with the 
alumni, and may well be understood to repre- 
sent their views and wishes, it is not easy to 
see how the introduction into the Board of Re- 
gents of five new members selected from the 



great body of alumni, not engaged at all in the 
work of the University, can add to the vigor 
and efficiency of her work ; and your commit- 
tee, therefore, find no reason to regret that the 
provisions of the charter are not sufficiently 
elastic to lead us to accept the recommendation 
in this particular of the General Alumni Asso- 
ciation ; and more especially is this the case 
when it is further borne in mind that the policy 
of the several faculties is to fill vacancies in 
their number, as they occur, from amongst the 
best-equipped of our alumni. 

While, therefore, we cannot recommend ac- 
ceptance of this recommendation, we see no 
reasonable ground of objection to the plan re- 
cently adopted by the Johns Hopkins Univer- 
sity looking to the selection of an advisory 
council of ten or fifteen from amongst the 
alumni, with whom, under suitable rules and 
regulations to be formulated by the Regents, 
consultations can be had relating to problems of 
Universitv administration and education, and 
we are free to say that we would welcome the 
appointment of such an advisory council, and 
do not doubt that valuable assistance would be 
given to the general work of the University by 
suggestions and advice from time to time from 
such representatives of the alumni. 

Your committee have also considered the 
subject covered by the preamble and resolution 
of the Alumni Association looking to the elec- 
tion of a paid provost or president. 

The charter does not contemplate the per- 
formance by the provost of active administra- 
tive duties calling for constant attention or su- 
pervision, and entitling the incumbent of the 
office to compensation, but there is no prohibi- 
tion against an enlargement of the duties which 
he is now performing, nor is there anything in 
the charter to prevent the Regents from affix- 
ing to the office of Provost a salary commensu- 
rate with the dignity of the position and the 
duties which, under proper rules and regula- 
tions, the Board of Regents are authorized to 
assign to him. 

The practical difficulty in the way of fixing 
a large salary to his official position is that the 
University has no endowment out of which 
such compensation could come, and accord- 
ingly the only source from which such com- 
pensation could be derived would be an assess- 
ment made by the Regents upon the shares of 
the tuition fees respectively received by the 



72 



THE HOSPITAL BULLETIN 



various members of our several faculties of in- 
struction. 

This, of course, would involve an annual re- 
duction of the amount received by each profes- 
sor, but we are sure that a moderate contribu- 
tion will be cheerfully agreed to by all the 
members of our teaching faculties in order to 
secure a closer supervision of the details of our 
university work by our presiding officer than 
has ever been expected from him or his distin- 
guished predecessor, if such additional supervi- 
sion shall be deemed necessary for the progress 
of the University. 

In answer to the suggestion of the General 
Alumni Association upon the subject, we rec- 
ommend that it be at once taken into consid- 
eration by a special committee, to be appointed 
for the purpose, consisting of one representa- 
tive from each of our five faculties, to report at 
our next regular meeting. 

In connection with this question of the elec- 
tion of a paid provost, your committees have 
also considered the additional vague and indefi- 
nite recommendations of representatives of the 
alumni for a reorganization of the University 
by the creation of "a governing body of trus- 
tees independent of the teaching bodies." 

The charter does not contemplate or warrant 
such a method of carrying on the work of the 
University, and so radical a change in our or- 
ganization does not commend itself to our 
judgment. 

It could not be made without a substantially 
new charter, and if this were obtained we do 
not perceive how the work which the Univer- 
sity is now doing with such gratifying effi- 
ciency and success could be enlarged and im- 
proved under the direction of a board of trus- 
tees, none of whom would be members of our 
several teaching bodies. 

To start with, there would be great difficulty 
in obtaining the services of public-spirited and 
properly qualified men who, without compen- 
sation, would give the necessary time and at- 
tention to the heavy and responsible labor of 
directing the administration of our several de- 
partments; nor can it be reasonably expected 
that our present force of professors would vol- 
untarily relinquish their positions and turn 
over to an entirely new Board of Trustees com- 
plete control of the affairs, property, resources 
and revenues of the University. 

Moreover, there is the initial and apparently 
insuperable difficulty in determining how and 
by whom this new Board of Trustees are to be 
selected. 

The small number of alumni from whom 
conies this request for the destruction of our 
existing organization do not suggest any way 
of solving this difficulty. 



If, however, these practical obstacles could 
be surmounted; if our present Board of Re- 
gents were to step down and out; if we had a 
new Board of Trustees clothed with full au- 
thority to administer the work of the Univer- 
sity in its several departments, with a paid 
Provost or President receiving a fairly large 
salary out of a fund yet to be raised in the dis- 
tant future, what reason is there to believe that 
we would have an increase in the number and 
quality of our students, or more efficient, 
thorough and successful teaching? 

In short, what better results can be looked 
for from a new governing body and a new fac- 
ulty of instruction for each of our several de- 
partments than we have now? 

Viewing this subject in every respect, we fail 
to see the benefits that would accrue to the 
University by annulling our present charter 
and taking a leap in the dark. 

As embodying our conclusions we submit 
the following resolutions : 

Resolved, That the Secretary be, and he is here- 
by, instructed to report to the Committee of 
Ten of the General Alumni Association that 
the Regents have carefully considered their 
recent communication proposing the election 
by the alumni of five representatives of the 
alumni, none of whom shall be full professors, 
as additional members of the Board of Regents, 
and that, upon an examination of the charter, 
the Regents find no warrant for such an addi- 
tion to their members; nor are the Regents in- 
clined to recommend to the General Assembly 
an amendment to the charter authorizing this 
proposed change in the organization of the 
Board of Regents. 

Resolved, further, That the Regents approve 
the election by the alumni of an Advisory 
Council, empowered to present from time to 
time to the Regents their views and wishes, 
and assure the Association of Alumni that the 
Regents will gladly welcome and always care- 
fully consider suggestions and recommenda- 
tions emanating from such Advisory Council. 

Resolved, also, That the Secretary report fur- 
ther to the Alumni Association that their sug- 
gestion with reference to the payment of a sal- 
ary to our Provost is now under consideration 
by the Regents, and shall be acted upon at an 
early date ; and further, that the Regents see 
no reason for a reorganization of the Univer- 
sity by "the creation of a governing body of 
trustees independent of the teaching bodies," 
and are, consequently, opposed to an amend- 
ment of the charter of the University in order 
to accomplish this suggested reorganization. 
John Prentiss Poe, 
Henry D. Harlan, 

R. DORSEY COALE, 

Thomas A. Ashby, 
John C. Hem meter, 
May 26, 1909. Committee. 



THE HOSPITAL BULLETIN 



73 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

EDITED BY 

A COMMITTEE OF THE HOSPITAL STAFF 



PUBLISHED BY THE 

HOSPITAL BULLETIN COMPANY 
University of Maryland 



Business Address, Baltimore, Md. 

Editorial Address University of Maryland 

Baltimore, Md., June 15, 1909 

EDITORIAL. 
The Recent Commencement at the Uni- 
versity of Maryland. — On May 31st, in the 
Academy of Music, the annual commencement 
of all of the Departments of the University of 
Maryland was held in the presence of a large and 
brilliant audience. The occasion was a most im- 
pressive one and the exercises were most inspir- 
ing. Degrees were conferred upon zyj students, 
the Medical Department leading with 89 grad- 
uates. 

The Bulletin takes pleasure in referring to 
the work of all the Departments of the Univer- 
sity which gives evidence of growth and im- 
provement during the past year. The joint com- 
mencement of the Departments, the splendid 
classes of young graduates and the combined in- 
terests of the Faculties in the educational work 
of the University, all show the continued growth 
of the University spirit and the progress which 
the University is making in the educational world. 
The man who fails to see the substantial gains 
which each Department of the University is mak- 
ing from year to year is a pessimist of deepest 
prejudice. The true friends of the University, 
who see facts in their proper light, must realize 
that this continued cry for radical changes in 
University management, for sudden upheavals 
of traditions and policies in its government, are 
not fully warranted at the present time. 

Every thinking mind knows full well that all 
methods may be improved under proper condi- 
tions. The work now carried on by each De- 
partment could be materially improved were con- 
ditions more favorable for radical reforms in 
policies and methods of government. With 
plenty of money and practical leadership it might 
be possible to bring about the changes which 
some of the optimistic friends of the University 



have so earnestly advocated. At the present time 
the University has neither plenty of money nor 
can she command that practical leadership which 
is so necessary to guarantee success in a depar- 
ture so radical as has been proposed. 

In the present Board of Regents the alumni of 
the University are liberally represented. We can- 
not believe that a Board of Trustees composed 
of men who are not connected with the different 
Faculties could, without a large endowment, con- 
duct the work of the University to better advan- 
tage to the University than the present Board of 
Regents, now so largely interested in the work of 
the different Departments. It would be well for 
those who are so active in urging radical de- 
partures from present methods of government to 
think well and wisely. Are the changes which 
they propose practical or rational at this time? 
Is it not more rational to assume that results will 
follow through gradual steps rather than by a 
sudden leap into the dark, which would most 
probably plunge the University into a whirlpool 
of disaster? 

In the world of education as in the world of 
commerce and trade, revolutions are most usually 
disastrous. The law of progress is grounded on 
established principles. Results only follow ra- 
tional and definite lines of action. The future 
growth of a greater University of Maryland 
must come through gradual steps, through prac- 
tical and conservative lines of policy, not by up- 
rooting the great system of a century's growth by 
violence and planting a lot of saplings which may 
never flourish. The men who now govern the 
affairs of the University are as jealous of her in- 
terests and are as anxious to enlarge her sphere 
of influence and usefulness as any of her alumni. 
They will not be diverted from their sense of duty 
to the University by spurious arguments or 
fanciful reasonings. As facts evolve they are 
prepared to grasp them, and as conditions war- 
rant methods and policies will be adjusted to meet 
them. 

Resignation of Prof. Samuel C. Chew. — 
The alumni of the University of Maryland will 
learn with profound regret that Professor Chew 
has resigned the chair of Professor of Medicine, 
which he has filled for so many years with rare 
grace, efficiency and distinction. Professor Chew 
was elected to the chair of Materia Medica and 
Therapeutic in 1864. Upon the retirement of 
Prof. Richard Mc Sherry from the Faculty of 



74 



THE HOSPITAL BULLETIN 



Physic in 1885, Professor Chew was elected to 
the chair of Principles and Practice of Medicine, 
which he has held until the present time with the 
recent change of the title of the chair, at Pro- 
fessor Chew's request, to Professor of Medi- 
cine. Professor Chew's service in the Faculty of 
Physic has exceeded in number of years the 
service of any one who has held a chair in the 
Faculty of Physic. It is but proper to say that 
no one who has ever filled a chair in the Univer- 
sity has rendered a more loyal, valuable and pop- 
ular service to the institution than has Professor 
Chew. His varied accomplishments as a teacher, 
his urbanity, dignity and pure character, his 
splendid influence over the student body and over 
the alumni, and his exalted position in this com- 
munity as a gentleman of the highest culture and 
refinement, are distinctions which it is permitted 
to few men to reach in any calling in life. 

We say it without hesitation that no man con- 
nected with the Faculty of Physic has ever been 
more beloved and esteemed by his associates in 
the educational work of the University than has 
been Professor Chew. His retirement from the 
active work of the chair he has so long graced 
has brought deep sorrow to his colleagues. We 
are happy to know, however, that as Emeritus 
Professor of Medicine we shall retain his deep 
and abiding interest in and loyalty to the old 
University. We wish many years of health and 
happiness to him in his retirement and pray rev- 
erently that the Giver of All Good will grant to 
him the satisfaction and rewards which should 
come from a life's work so given up to the high- 
est aims and ideals of service to his fellow-man. 

Commencement Exercises and Degrees 
Conferred. — Degrees were conferred upon 237 
graduates in the arts and sciences, medicine, law, 
denistry and pharmacy at the annual commence- 
ment of the University of Maryland at the 
Academy of Music, Monday, May 31, 1909. 
Among the graduates were three young women, 
one in dentistry and two in pharmacy. Five hon- 
orary degrees were also conferred. 

Among those upon whom honorary degrees 
were conferred were Chief Judge Andrew Hun- 
ter Boyd, of the Court of Appeals, and Dr. John 
Allan Wyeth, of New York, who delivered the 
address to the graduates. 

In presenting the name of Chief Judge Boyd 
for the degree Mr. John P. Poe, Dean of the 
University, said : 

"One of the most gratifying facts in our 



Maryland history is that the chief justices of 
our Court of Appeals have always been men of 
pre-eminent professional distinction. In casting 
our eyes over the list of those who from the 
foundation of the court down to the present time 
have presided over its deliberations the record 
shows that its chiefs have invariably been 
learned, laborious, discriminating, always uniting 
attractive clearness of statement with convincing 
strength of reasoning in their judicial opinions. 

"Proudly rejoicing in the fame of those who 
in their exalted position led the court for many 
past generations in the administration of a pure 
and enlightened justice, we of this generation 
are equally proud to know that our present chief, 
Andrew Hunter Boyd, maintains the high rank 
of his distinguished predecessors in the command- 
ing qualities and endowments which, in symmet- 
rical proportions, give us the lofty measure of a 
most accomplished and honored judge and gen- 
tleman. 

"His work for 16 years upon the bench, fol- 
lowing a deservedly successful career at the bar, 
justly entitles him to public admiration and 
praise, and I count it a high privilege to be com- 
missioned by the Regents of the University to 
present him to you for the honorary degree of 
Doctor of Laws." 

Another honorary degree conferred was that 
of Doctor of Divinity upon Rev. John Timothy 
Stone, formerly pastor of Brown Memorial 
Church. Mr. Stone was not present. His name 
was presented by Judge Stockbridge. 

The other honorary degrees conferred were 
those of Master of Arts upon Mr. Isaac Brooks, 
]r., and Doctor of Sciences upon Dr. Rupert Lee 
Blue, of the Marine Hospital Service in San 
Francisco. 

Mr. Bernard Carter, Provost of the Univer- 
sity, conferred the degrees, the candidates for 
which were presented by the Deans of the re- 
spective faculties. Dr. Wyeth spoke mainly to 
the graduates in medicine, being better ac- 
quainted, as he said, with what was required of 
that profession. A clean, healthy life, sobriety 
and self-control, he said, are most essential to 
the physician. As the greatest work of the physi- 
cian is to prevent, rather than to cure, diseases, 
he also said, he thought the ideal lawyer is one 
who will settle disputes, rather than promote liti- 
gation. 

After Dr. Wyeth' s address the names of the 
graduates were called, and they went upon the 



THE HOSPITAL BULLETIN 



75 



stage ami received their diplomas. Dr. Thomas 
Fell, of St. John's College, which is a part of the 
University, presented the candidates for the de- 
gree of Bachelor of Arts and Bachelor of Sci- 
ences. Dr. R. Dorsey Coale presented the can- 
didates for the degree of Doctor of Medicine; 
Mr. John P. Poe, the candidates for the degree 
of Bachelor of Laws; Dr. Ferdinand J. S. Gor- 
gas, the candidates for the degree of Doctor of 
Dental Surgery, and Dr. Charles Caspari, Jr.. 
the candidates for the degree of Doctor of 
Pharmacy. 

The names of the graduates are as follows : 
Bachelor of Arts (all from Maryland )— Lloyd C. 
Bartgis, J. Irvin Dawson, J. Alexander Kendrick, Ar- 
thur Rufus Laney, Harrison McAlpine, Allan H. St. 
Clair, Edwin Warfield, Charles L. Weaver and Frank 
H. Gauss. 

Bachelor of Sciences (all from Maryland)— William 
B. Ennis, Clarence T. Johnson, R. Elmer Jones and 
Albert Knox Starlings. 

DOCTOR OF MEDICINE. 
Maryland— Clarence Irving Benson, William Ward 
Braithwaite, Norman Irving Broadwater, Arthur Louis 
Fehsenfeld, Harry Baldwin Gantt, Jr., Morris Baldwin 
Green, Joseph Ward Hooper, Samuel Herman Long, 
James Finney Magraw, William E. Martin, James Win. 
Meade, Jr., Wilmer Marshall Priest, William Gwynn 
Queen, Louis Hyman Roddy, John T. Russell, John G. 
Schweinsberg, Reed A. Shankwiler, Claude C. Smink, 
Maurice Isaac Stein, Frederick Henry Vinup and Wal- 
ter Franklin Weber. 

Virginia— Carroll Augustus Davis, Julian Mason Gil- 
lespie, Preston Hundley, Joel Cutchins Rawls, John 
William Robertson, Hugh W. Smeltzer, Charles Frank- 
lin Strosnider and Eugene Bascom Wright. 

West Virginia— William John Blake, Simon Wick- 
line Hill and John Nelson Neill Osburn. 

North Carolina— Darius Cleveland Absher, Branch 
Craig, J. Ernest Dowdy, Edgar Miller Long, Ross Si- 
monton McElwee, John Sanford Mason, James Left- 
wich Moorefield, John Standing Norman, Lytle Neal 
Patrick, Frederick Wharton Rankin, Nealc Summers 
Stirewalt, Charles LeR. Swindell, Asa Thurston and 
John Bruce Weatherly. 

South Carolina — Maxey Lee Brogdcn, Paul Brown, 
Arthur E. Cannon, William Thornwell Gibson, Ever- 
ette Iseman, Thomas Alexander Patrick, Furman 
Thomas Simpson and T. Hayne Wedeman. 

New York— William S. Campbell, Edwin B. Goodall, 
Harry M. Robinson and R. Gerard Willse. 

New Jersey — Charles Herbert Johnson, William Wal- 
ter Kettele and Budd Jameson Reaser. 

Canada — A. Marvin Bell and Ralph Norvel Knowles. 

Ohio — George E. Bennett. 

Florida— Clarence Bythell Collins, James P. Parra- 
more and Adam Clark Walkup. 

Georgia — Robert H. Gantt, Benjamin Harrison Gib- 
son and Lehmon W. Williams. 

Rhode Island — Howard Barton Bryer. 



Massachusetts — Arthur Judson Cole ami Alfred Chase 
Trull. 

Pennsylvania — Thomas Robert Dougher, James A. 
Hughes, Adam Seanor Kepple, John Lindsey Mess- 
more, Charles A. Neafie and J. W. Ricketts 

Delaware — George Edward James. 

Minnesota — Howard Kerns. 

Nebraska — Cleland G Moore. 

California — Samuel Jackson Price. 

Iowa — Lynn J. Putman. 

Cuba — Miguel A. Buch y Portuondo. 

Porto Rice — Jose Y. de Guzman Soto. 

England — Thomas Gilchrist. 

Syria — Jemil Abdallah el Rassy. 

These appointments were made to the Llni- 
versity Hospital : 

Resident Physicians — Joseph L. Hooper, W. H. Queen 
and J. L. Robertson. 

Resident Surgeons— G. H. Richards, T. M. West, N. 
Irving Broadwater, Frederick Rankin and James S. Mc- 
Graw. 

Resident Gynecologists — I. S. Wilsie and C. C. Smink. 

Resident Pathologist— J. W. Ricketts. 

Resident Obstetricians — A. II. Hughes, John N. Os- 
born and C. C. Cannon. 

Resident Physicians at Bayvicw — Branch Craig, J. S. 
Norman and 11. I'.. Gantt, Jr. 

Relief Fund for Dr. Jas. Carroll's Family. 
— It has been suggested by some of the alumni 
of the University of Maryland that The Hos- 
pital Bulletin should attempt to raise a spe- 
cial contribution to the "Relief Fund for Dr. 
James Carroll's Family," now being raised by 
the Journal of the American Medical Associa- 
tion. The Bulletin will cheerfully forward all 
contributions made through it to this fund. 
Any of the alumni of the University who desire 
to contribute t<> this fund can do so by for- 
warding their contribution direct to the Journal 
of the American Medical Association or 
through The Bulletin. The following letter 
from Dr. S. W. Hammond, class 1905, explains 
the situation : 

"1 would beg to invite your attention to the 
call made on the medical profession for 'Relief 
of Dr. Carroll's Widow' — Journal American 
Medical Association, April 3rd, page 1122, also 
editorial in same issue. I want to contribute to 
that fund, and feel that every alumnus of the 
University of Maryland would be glad to con- 
tribute. Dr. Carroll had the honor of being an 
alumnus, and none the less the U. of M. has 
the honor of being Dr. Carroll's alma mater. 
It occurs to me that it is a rare opportunity for 
our alma mater, through the alumni, to show 
her appreciation in a substantial wav. 



76 



THE HOSPITAL BULLETIN 



"The idea is to get up a fund, say in the name 
of 'Alumni University of Maryland.' It will do 
the old University good. Not that we would 
be acting Pharisee, hut fulfilling that holy in- 
junction to 'let your light so shine," etc. And 
as an afterthought, there might as a result be 
established a precedent that, should any alum- 
nus of the University of Maryland who has de- 
voted his time, talent and energies unselfishly 
to the advancement of science and the protec- 
tion of the life and health of humanity, such an 
one would feel encouraged in his altruistic ef- 
forts. I believe that a large number of the 
alumni can be reached through The Hospital 
Bulletin. Details for ways and means for con- 
ducting the campaign through The Bulletin I, 
of course, leave to be worked out by those in 
charge, except to say that we can make our 
contributions for this fund. Relief of Dr. Car- 
roll's Widow, etc.. to The Bulletin", and the 
amount be turned over to the proper authori- 
ties as a whole, as above indicated. You will 
note in the Journal American Medical Associa- 
tion that all contributions are publicly acknowl- 
edged in its columns. I don't think we crave 
anv self-aggrandizement by seeing our indi- 
vidual names set opposite our respective 
amounts contributed, but would like to see our 
old alma mater do her maternal duty and get 
the honors she deservedly merits." 

Resolutions to Prof. Chew. — In considera- 
tion of the long and distinguished services 
rendered by Professor S. C. Chew, and 
as an evidence of the esteem and affection 
held for him by his colleagues of the Faculty 
of Physic, all of the members of the Faculty in 
the city visited Prof. Chew at his beautiful 
home, in Roland Park, on the afternoon of June 
4th. and presented to him through their chair- 
man, Prof. C. W. Mitchell, the following reso- 
lutions. 

Professor Mitchell, in presenting these reso- 
lutions, made the following remarks : 

"We all feel, dear Dr. Chew, that something 
more than words of formal resolution should 
be said on this occasion. We come rather as 
medical children to a beloved father to tell once 
more our story of gratitude and love, and to 
seek counsel and advice. Your resignation 
severs the last link that binds the majority of 
us to our former teachers, and we are loth to 
give you up. W r e want to maintain the high 
traditions which you for so many years have 
typified. We still want to breathe in your 



spirit. In our sadness we have the one con- 
solation that in this beautiful library and home 
you have the solace of the world's best thought, 
the joy of religion, and the loving care of a de- 
voted family." 

Whereas, We, the members of the Faculty 0/ 
Physic. University of Maryland, have received 
with profound sorrow the resignation of our 
revered and beloved colleague. Prof. Samuel C. 
Chew, and whereas his long service has been 
marked by ripe scholarship, high intellectual 
ideals, rare charm and grace of spoken and 
written word, didactic and clinical teaching of 
singular power and effectiveness, and by a per- 
vasive moral force that quickened and refined 
all whom it touched ; 

Be it Resolved, That we accept the resignation 
of Prof. Chew with great regret and with the 
deepest feelings of esteem, affection and grati- 
tude : and be it further 

Resolved, That we wait upon Prof. Chew in a 
body to personally extend these resolutions to 
him, to request that he accept the title "Emeritus 
Professor of Medicine," and to express the hope 
that his remaining years may be spent in com- 
fort and happiness and with the satisfaction 
which comes from a long life of high purpose and 
great achievement. Be it further 

Resolved, That an engrossed copy of these 
resolutions be forwarded to Prof. Chew, signed 
by every member of the teaching staff of the Uni- 

versity. 

ALUMNI DAY. 

Many of the representative medical schools are 
setting aside a day — Alumni — during their com- 
mencement exercises on which past graduates 
are invited to return and renew their allegiance 
to their Alma Mater. In order to make the visit 
profitable, instructive and sociable, various clinics 
are held, in the specialties as well as in general 
medicine and surgery ; the buildings are inspected 
and class and general reunions held. It is the 
plan of Jefferson Medical College of Philadel- 
phia, Pa., to celebrate such a day June 7, 1909. 
A like celebration by the University of Maryland 
would be a step in the right direction. We are 
doing a magnificent work of which many of our 
alumni are unaware. Indeed a large proportion 
of our graduates after commencement day never 
re-enter the portals of their Alma Mater, conse- 
quently they have no first-hand knowledge of 
what we are doing or have accomplished since 
they left us. If we can provise means for bring- 
ing them back, perhaps they will feel more kindly 
disposed to us. An Alumni Day would do much 
to accomplish this ; at any rate Buffalo Univer- 
sity. Harvard University, University of Penn- 
sylvania and Jefferson Medical College think so. 
Surely they would be surprised at the quality 
and diversity of our work. If we had a presi- 
dent, this is one of the first matters he would 
take up. and shows our crying need for a direct- 
ing force. 



THE HOSPITAL BULLETIN 



77 



ITEMS. 



At the annual meeting of the Medical and Chi- 
rurgical Faculty, held at their new building, 121 1 
Cathedral street, the following of our alumni 
were elected to office for the ensuing year: 
President, Dr. G. Milton Linthicum, M. A., De- 
partment Arts and Sciences, St. John's College ; 
vice-president, Dr. Compton Riely ; member of 
the Board of Trustees, Dr. D. E. Stone, class 
of 1864, Mt. Pleasant; councillors, Dr. Guy 
Steele, Cambridge; State Board Medical 
Examiners, Dr. Lewis B .Henkel, Annapolis ; 
Dr. Herbert Harlan is president of the Board 
of Medical Examiners and Dr. W. W. Golds- 
borough is a member; delegates to American 
Medical Association, Dr. S. T. Earle ; Commit- 
tee on Scientific Work and Arrangements, Dr. 
A. M. Shipley; Library Committee, Dr. J. W. 
Williams ; Committee on Public Instruction, 
Drs. M. C. Cromwell, Eugene Kerr; Commit- 
tee on Widows and Orphans, Drs. E. F. Cor- 
dell, Theodore Cooke, Sr. ; Memoirs Commit- 
tee, Drs. J. T. Smith, G. H. Cairnes ; Commit- 
tee on Medical Education, Dr. Randolph Wins- 
low; Sanitary and Moral Prophylaxis, Dr. O. 
E. Janney ; Committee on Tuberculosis, Drs. 
P. Travers, R. B. Norment ; Committee on 
Pure Food, Dr. N. R. Gorter. 



Dr. Wm. T. Watson, of Baltimore, sailed 
June 3 on steamer Bremen, and will spend the 
summer in Germany. 



Mrs. Warren Grice Elliott has sent out invi- 
tations for the marriage of her daughter, Eliz- 
abeth Preston, to Dr. Gordon Wilson, on Sat- 
urday. June 5, at 6 o'clock, at St. Paul's 
Church, Baltimore. 



Dr. and Mrs. John C. Hemmeter have taken 
a cottage for the summer season at Portland, 
Me. 



Dr. Rankin, Dean of the Wake Forrest Col- 
lege, North Carolina, recently spent a few days 
in Baltimore. 



Mrs. Walter Levy, wife of Dr. Walter V. S. 
Levy, is a patient in the University Hospital. 



Dr. and Mrs. Tunstall Taylor will spend the 
summer at Blue Ridsre Summit. 



The Hospital for the Women of Maryland, 
among other improvements, will dedicate op- 
erating rooms to the memory of Dr. W. T. 
Howard and Dr. H. P. C. Wilson. 



The sixty-third annual commencement of 
the Medical Department of the University of 
Buffalo was held May 28, 1909. Alumni Day 
was celebrated with appropriate ceremonies 
May 25, amongst which were special clinics for 
the alumni visitors. This event seems to be a 
fixed feature of the Northern colleges. We 
could imitate them with profit both to our- 
selves and our visitors. 



Dr. John C. Hemmeter, professor of physiol- 
ogy in the University of Maryland, has been 
named as one of the committee of patrons for 
the dedication of a monument to Michael Ser- 
vetus, in Vienne, near Lyons, France, August 
14, 1909. 



Dr. Julian \Y. Ashby, of Carbon, W. Va., re- 
cently spent a few days' vacation in Baltimore. 



Dr. G. B. Harrison, of Hot Springs, Va., re- 
cently paid a hurried visit to Baltimore. 



Dr. and Mrs. D. M. Culbreth will spend the 
summer sojourning in the North. 



Dr. and Mrs. Wm. H. Baltzell will occupy 
their summer home, Elm Bank, Wellesley, 
Mass., for the summer months. 



Dr. and Mrs. Nathan R. Gorter will summer 
at the Chattolanee, Green Spring Valley, Md., 
where Dr. Gorter is the resident physician. 



Dr. Eldridge C. Price, class of 1874, of Balti- 
more, read a paper on "The Imminent Danger 
of Extinction Which Threatens the Homeo- 
pathic School in the State of Maryland as a 
Distinctive Branch of the Medical Profession ; 
and the Remedy," before the annual meeting of 
the Maryland State Homeopathic Medical So- 
ciety. 



Dr. Charles H. Riley, class of 1880, de- 
livered the graduation address to the nurses 
of the Shepperd and Enoch Pratt Hospital 
School for Nurses. Dr. Riley is vice-president 
of the trustees. 



78 



THE HOSPITAL BULLETIN 



At the commencement of the University of 
Maryland, held at the Academy of Music May 
31, the honorary degree of LL. D. was con- 
ferred on Chief Judge Boyd, of the Maryland 
Court of Appeals, and Dr. John A. Wyeth, of 
New York, who delivered the address to the 
graduates. Dr. Wyeth is well known as a 
Confederate soldier and historian, as well as 
for his surgical writings. 



Dr. Louis Seth, assistant physician at Sabil- 
lasville, has been spending a few days in Balti- 
more. He is looking hale and hearty, and re- 
ports that he never felt better in his life. His 
looks do not belie him. We are glad to report 
that he has made such rapid strides toward the 
resrainal of his health. 



Dr. A. A. Matthews, class 'of 1900, of Spo- 
kane, Wash., who has recently been quite ill 
with grip, we are glad to report to his friends 
has entirely recovered. 



Dr. George C. Winterson, class of 1902, has 
located at Red Cloud, Nebraska. The reports 
are that he is succeeding in building up a nice 
practice. 



Drs. Charles W. Famous and Walter T. 
Messmore, both of the class of 1901, attended 
the banquet. 



Dr. James P. Parramore, class of 1909, has 
received an appointment as assistant resident 
surgeon at St. Joseph's Hospital, Baltimore. 



Dr. Silas Baldwin, 700 West Lafayette ave- 
nue, Baltimore, was thrown to the ground and 
injured while driving in Druid Hill Park, May 
30, 1909. 



Dr. Samuel J. King, class of 1902, of Balti- 
more, will leave during the latter part of June 
to locate at Winnemucca, Nevada. 



Dr. J. C. Robertson, class of 1900, who has 
been quite ill, is reported to be improving. 



E. P. Tignor, D. D. S., M. D., relieved from 
temporary duty at Fort Monroe, will proceed 
to Fort Slocum, New York. 



Dr. E. F. Cordell delivered addresses before 
the District of Columbia Branch of the General 
Alumni Association at Washington, April 29, 
and the Pennsylvania Branch at York, May 1. 



The annual meeting of Baltimore County 
Medical Association was held in Towson, May 
20. Dr. Bennet F. Bussey. 1885, Cockeysville, 
was elected president ; Dr. Richard C. Massen- 
burg, Towson, corresponding secretary; Dr. 
Josiah S. Bowen, Mount Washington, record- 
ing secretary, and Drs. H. Lewis Naylor, 
Pikesville, and L. Gibbons Smart, Lutherville, 
were elected delegates to the Medical and 
Chirurgical Faculty of Maryland. 



Dr. Charles Franklin Strosnider, class of 
1909, has been appointed assistant superintend- 
ent of the James Walker Memorial Hospital, 
Wilmington, N. C. 



Dr. Martin L. Jarrett, class of 1864, of Balti- 
more, was recently elected commander of the 
James R. Herbert Camp, United Confederate 
Veterans. 



The following of our alumni are connected 
with the Northeastern Dispensary, according 
to their Fifty-sixth Annual Report : Secretary, 
Dr. A. D. McConachie; executive committee. 
Dr. A. D. McConachie; directors, Dr. George 
A. Hartman, Dr. A. D. McConachie ; general 
medicine, Dr. P. E. Lilly, class of 1901 ; dis- 
eases of children. Dr. A. L. Levy; nose and 
throat, Dr. J. C. Robertson ; eye and ear, Dr. 
A. D. McConachie ; eye and ear, Dr. J. S. 
Bowen ; skin. Dr. Fred Wilkins ; chief of out- 
door clinic, Dr. P. E. Lilly. 

The following of our alumni are connected 
with the South Baltimore Eye, Ear, Nose and 
Throat Charity Hospital : Consulting medical 
and surgical staff, Dr. Samuel Theobald, Dr. 
Hiram Woods, Dr. J. Frank Crouch, Dr. Chas. 
O'Donovan ; assistant surgeon, Dr. J. F. Haw- 
kins. 

Dr. N. G. Keirle is director of the Pasteur 
Institute, College of Physicians and Surgeons ; 
Dr. Charles F. Bevan, class of 1871, is dean of 
the same school. 



Dr. and Mrs. L. Ernest Neale will go to 
Ocean City for the summer. 

Dr. G. Milton Linthicum, the new president 
of the Medical and Chirurgical Faculty, is an 
alumnus of the University of Maryland, having 
obtained a portion of his collegiate education 
at St. John's College, our department of arts 
and sciences. 



THE HOSPITAL BULLETIN 



7i> 



Drs. T. A. Ashby and Charles O'Donovan 
made addresses at the annual meeting of the 
Medical and Chirurgical Faculty; Dr. H. O. 
Reik made the report of The Bulletin commit- 
tee; Dr. J. L. Hirsh read a paper on "Family 
Epidemic of Acute Trichiniasis ;"' Dr. F. J. 
Kirby read a paper on "Tumors of the Carotid 
Gland, Report of a Case ;" Dr. H. O. Reik, "An 
Atlas of Otology, Illustrated by the Epydia- 
scope :" Dr. G. Timberlake, "Demonstration of 
Spirochetae Pallida by Dark Field Illumina- 
tion;'' Dr. R. II. Johnston, "Direct Laryngo- 
scopy." 



At the meeting of the Anne Arundel Counts 
Medical Society, held April 16, at the Hotel 
Maryland, Annapolis. Dr. F. H. Anderson, 
class of 1870, read a highly instructive and in- 
teresting paper on "The Treatment of Typhoid 
Fever." Among those present were Drs. H. B. 
Gannt, Millersville ; C. R. Winterson, Elk- 
ridge; L. P.. Ilenkel, Annapolis; J. S. Billings- 
lea, Armiger. 



Dr. J. R. Downs, class of 1904, is secretary of 
Caroline County Medical Society. 



At the regular meeting of the Howard Coun- 
ty Medical Society, held at the Howard House, 
Ellicott City, April 6, 1909, our alumni were 
elected to the following offices for the ensuing 
year: President, Dr. T. B. Owings, class of 
1852; vice-president, Dr. Wm. R. Eareckson. 
Dr. F. O. Miller was appointed one of a com- 
mittee to secure a permanent meeting place. 
Dr. Frank Janney addressed the society on the 
aural complications most frequently met with 
following grip. 



Dr. Samuel T. Earle will read a paper on "A 
Review of Proctologic Literature for 1908" at 
the coming meeting of the American Procto- 
logic Society, to be held at Atlantic City, June 
7. 1909; also a paper on "Tubercular Fistula 
with Extensive Infiltration, with Specimen Ex- 
hibited." Dr. J. Rawson Pennington, class of 
1887, of Chicago, "Further Observations in the 
Use of Bismuth Paste in the Treatment of 
Rectal Fistula." 



Dr. S. R. Donohoe, class of 1902, of Norfolk, 
Va., writes : "Two men of the class of 1905 — 
H. E. Jenkins and W. J. Riddick — have passed 
the examination for the Medical Department of 



the United States Navy. They stood the ex- 
amination in Washington last week, and 
among a number of applicants were the only 
successful candidates. Things of this sort mean 
something for the old University. We all take 
pride in the success of the alumni, and their 
friends will be glad to hear of their good for- 
tune." The editors desire to take this occasion 
to congratulate both Drs. Jenkins and Riddick 
on their successful accomplishment of a task 
and attainment of a position desired by many, 
but actually realized by less than 20 per cent, 
of those taking the examinations. It i^ such 
men as these that reflect credit upon those who 
have taught them and their alma mater. 



We have heard that Dr. A. D. Tuttle. class 
of 1906, a veteran of the Filipino and Chinese 
Wars, and withal a good fellow and student, 
has successful!}' passed the Army Medical Ex- 
amining Board and is now a first lieutenant in 
the Medical Corps, United States Army. We 
also extend to Dr. Tuttle our congratulations 
upon his success, and hope that if the occasion 
offers he will shed as much lustre upon his 
school as Carroll and Victor Ruppert Blue. 



Commencement exercises took place at St. 
John's College (Department Arts and 
Sciences). Annapolis, June 1 1 to June 16. Of 
particular interest was the celebration of the 
one hundred and twenty-fifth anniversary of 
the chartering of St. John's College as a colle- 
giate institute. St. John's was founded as King 
William's School in 1G89, and in 1784 it was 
merged into St. John's College. Only Har- 
vard, at Cambridge. .Mass., and William and 
.Marv, at Williamsburg, Va., antedate St. 
John's in their beginnings as institutions of 
learning. 

The exercises commemorative of the found- 
ing of the college will take place on Wednesday, 
June 16, the same day that the class graduates. 
( )ver 50 of the leading institutions of learning 
of the country will be represented by their 
presidents or prominent members of the faculty 
or alumni. The list includes all of the institu- 
tions in this vicinity, with most of the others 
throughout the country which are notable for 
their historic interest or on account of their 
prominence in the intellectual life of the nation. 

x\bout 15 graduates will receive degrees of 
bachelor of arts and bachelor of science, while 
a number of distinguished alumni and others 
will receive honorary degrees, among whom is 
Dr. Randolph Winslow, who receives an 
LL.D. 



80 



THE HOSPITAL BULLETIN 



Dr. Taylor E. Darby, class of 1904, is located 
at Barnesville, Montgomery county, Md. 



Dr. C. Urban Smith is connected with the 
Faculty of the Maryland Medical College. 



Dr. Louis H. Seth, formerly assistant resi- 
dent physician in the hospital, is at present as- 
sistant resident physician in the Tuberculosis 
Sanitarium, Sabillasville. Dr. John C. Hem- 
meter delivered the address of the occasion to 
the graduates of the Hebrew Hospital Training 
School for Nurses. Amongst others who spoke 
were Drs. J. L. Hirsh and Harry Adler, who, 
with a few appropriate words, distributed the 
diplomas. 



Dr. and Mrs. Eugene Raphel. of Wheeling, 
W. Va., have been the guests of Miss Edgarina 
Hastings, niece of Judge Martin Morris, with 
whom she makes her home at 13 14 Massachu- 
setts avenue, Washington, D. C. 



Dr. Robert W. Crawford, class of 1906, of 
Rocky Mount, N. C, paid the city and the Uni- 
versity Hospital a visit recently. 



Dr. James Taylor, of North Carolina, re- 
cently stopped at the University Hospital. 



Mr. and Mrs. Alfred Courtney Doyle, of The 
Hylands, Walbrook, have announced the en- 
gagement of their daughter, Agnes Hegg, to 
Dr. John Wilson MacConnell, of Davidson, N. 
C, formerly resident physician at the Presby- 
terian Eye, Ear and Throat Hospital, Balti- 
more. 



The residents and graduating class of the 
University of Maryland Medical School re- 
cently gave a farewell dance at Albaugh's The- 
atre in honor of the nurses of the University 
Hospital. Among those present were : Misses 
Wilson, Wright, Israel, Chapline, Almond, Ely, 
Barrett, Murchoin, Robey, Tess. Salisbury, 
Garrison, Tull, Kimmel ; Drs. Bird, Hammond, 
J. H. Bay, Kolb, Coleman and West ; Messrs. 
Hooper, Wright, Gannt, Queen, Broadwater, 
Ricketts, Moorefield. Brown. Mason, Osborn 
and Kirk. 



A memorial service was held at Central 
Young Men's Christian Association for Dr. E. 
T. Duke. 



Dr. G. B. Harrison is superintendent of the 
Green Brier General Hospital, Ronceverte. \Y. 
Va. 



Dr. Hiram Woods presided at the second 
annual meeting of the Maryland Society of 
Social Hygiene. 



The annual reunion of the Medical Alumni 
Association of the University of Maryland and 
banquet were held at the Eutaw House, Balti- 
more, Md.. Monday night, May 31. 1909. At the 
business meeting Dr. Thomas M. Chaney, the 
president presided, and in the absence of Dr. 
Sadtler, the secretary, Dr. James M. Craighill 
acted pro tern. Several new members were 
elected to membership. Dr. Cordell reported 
that the endowment fund now amounted to a 
little over $19,000. A few reminiscent remarks 
were indulged in by Drs. Cordell. Taneyhill 
and Ashby. A motion to disband the associa- 
tion and amalgamate with the General Alumni 
Association was proposed, but defeated. This 
motion brought forth a heated discussion, both 
pro and con. 

Officers for 1909-10 were elected as follows : 
President, Wm. H. Pearce, M. D. ; vice-presi- 
dents, Guy Steele, M. D., Joseph Smith, M. D., 

A. C. Pole, M. D. ; recording secretary, Charles 
E. Sadtler, M. D. ; assistant recording secre- 
tary, J. F. H. Gorsuch, M. D. ; corresponding 
secretary, John Houff, M. D. ; treasurer, John 
I. Penington, M. D. ; executive committee, A. 
D. McConachie. M. D., Geo. H. Hocking, M. 
D., C. A. Winterson, M. D„ B. M. Hopkinson, 
M. D., G. Lane Taneyhill, M. D. 

The banquet was enlivened by solos by Dr. 

B. Merrill Hopkinson and Mr. Lynn Hobart. 
During the courses Hesse's Orchestra dis- 
pensed music. About 150, including the grad- 
uating class, which was the guest of the medi- 
cal faculty, were present. 



Dr. A. E. Landers is located at Crumpton, 
Md. 



Dr. K. M. Jarrell, class '06. is now practicing 
in Clear Creek. YV. Ya. Dr. Jarrell writes that he 
has built up a large practice and is having fine 
success. He has recently been appointed 
health officer for Raleigh count}-, W. Va., for 
four years, with a fair salary attached. He ex- 
pects to visit Baltimore during the present 
month. 



Dr. J. A. Devlin, class of 1906, writes in part: 
''I am sending you a copy of the report of St. 
Francis Hospital, of which I am now house 
surgeon. I should have been in this illustrious 
position a year ago, but spent most of the year 
of 1007 in bed. the rest in sulphur baths at 
Richfield Springs. I had acute articular rheu- 
matism and the •trimmings on the endocardium 
which go with it. Altogether had a very nice 
part}-. I resumed my work here January 1st, 
1908. I get Tin-: Bulletin regularly, and it is 
very interesting to me. I often wish I could 
stop work for a while and pay a visit to you all, 
and perhaps aid in coaching a team (football) 
to beat Hopkins. 



THE HOSPITAL BULLETIN 



81 



DEATHS. 
Dr. Benjamin F. Lansdale, 64 years old, lor 
40 years a practising physician at Damascus, 
Md., died May 21, 1909, at his home, in Damas- 
cus, of cancer of the stomach. Surviving him 
is a widow, who was a daughter of the late Phil- 
emon M. M. Smith, of Gaithersburg, and three 
children — Dr. P. Smith Lansdale, of Ohio; Mrs. 
John Lewis and Mrs. Beall, of Damascus. Dr. 
Lansdale was born in Washington and was a 
son of the late Henry Nelson Lansdale, of that 
city. He was educated in Washington and 
Baltimore, and was graduated from the Uni- 
versity of Maryland, class of 1866, beginning 
the practice of his profession soon afterward. 



Dr. Willis Alston, class of 1869, a member 
of the Medical Society of the State of North 
Carolina, and one of its founders, for six years 
a member of the State Board of Medical Ex- 
aminers, died at his home, in Littleton, April 
20, 1909, aged 62. 



Dr. Charles W. Harper, class of 1869, one of 
the best-known residents of Halethorpe, Md., 
died May 14, 1909, at his home, from infirmities 
of old age. Dr. Harper was about 70 years old 
and had practiced medicine in Halethorpe 
many years. He is survived by his wife. 



Dr. John Kilgour White, class of 1884, of 
Woodland, Md., died suddenly from pneumonia 
April 4, 1909. 



Dr. Roger Brooke, class of 1887, of Sandy 
Springs, Md., 62 years old, for many years a 
leading physician, died May 9, 1909. He had 
an attack of acute indigestion about April 1. 
and this developed into a heart weakness which 
caused his death. 

Dr. Brooke was highly regarded for skill and 
faithfulness in practice. He participated in all 
public-spirited enterprises, being a most active 
spirit in the organization of the Enterprise Tel- 
ephone Company, a local corporation, and was 
its president and general manager for several 
years, and was president at the time the com- 
pany was sold to the Chesapeake and Potomac 
Company a few years ago. At the time of his 
death he was a member of the committee hav- 
ing in charge the construction of the high 
school building here. The good-roads question 
interested him deeply, and he earnestly partici- 
pated in every effort directed toward abolishing 
tollgates. lie was an active member of Mont- 
gomery County Medical Society and had 
served as its president. 

Surviving him are his widow, Mrs. Louisa 
T. Brooke, and five children — Mrs. Emilie B. 
Coulter, Miss Sallie Brooke, of Sandy Spring; 
Mrs. N. G. Smith, of Auburn, Me.: Dr. Roger 
Brooke, an army surgeon, and Edward T. 
Brooke. 



The funeral took place May 11, 1909, from 
the family residence, and was attended by one 
of the largest gatherings ever seen at a funeral 
in that section of the county. The services 
were those of the orthodox branch of the So- 
ciety of Friends, of which Dr. Brooke was a 
prominent member. Walter Brooke, Caleb 
Stabler, Tarlton Brooke and Fred L. Thomas, 
nephews of Dr. Brooke, and Joseph Janney and 
Dr. George E. Cooke were the pallbearers. The 
interment was in Woodside Cemetery, near 
Ashton. 

Oh, why has worth so short a date? It is 
only the loss of such a man as Roger Brooke 
that can teach his mourners — who comprise all 
who knew him — what was his real value to the 
people among whom he lived. It is no dispar- 
agement to those who are left to say that there 
is no other person in the entire neighborhood 
who could so ill have been spared. As a citizen 
he performed his full duty, taking a prominent 
part in measures for the benefit and uplift of 
the community; as a man he won the respect 
and warm friendship of a large circle, always 
being guided by what he believed to be right ; 
as a husband his life for nearly forty years was 
the highest type and example of consistent de- 
voted love ; as father and grandfather he com- 
bined wise counsel with affectionate tender- 
ness, so that the grief of his children may well 
be tempered by thankfulness that they are sons 
and daughters of such a parent ; as a true fol- 
lower of Christ he was a comforter to many in 
their hours of bereavement by his words of 
deep feeling and simple eloquence, while his 
sincere religious nature was shown in all 
church work — as a physician — though he did 
not take up that vocation until late in life, and 
against the advice of nearly all his friend: — his 
sucess was marvelous. I do not speak of that 
poor sort of success which is measured by dol- 
lars and cents, but veal success, manifested by 
saving lives, relieving suffering and distress, and 
making the world better and happier because 
of his having lived in it. How many families 
have had intense anxiety changed to comfort 
and reassurance by his efficient ministrations ! 
And with what forebodings we now face the 
future ! The martyr's crown grows dim and 
lusterless, the hero's wreath fades and withers, 
compared with such services as he rendered 
during his long years of practice. Perhaps the 
exposure during the stormiest night of last 
winter may have hastened his end, but there 
was no more thought of failure to respond to 
the call of duty than if he had been a patriotic 
soldier on a battlefield. 

It is not for us weak mortals to understand 
why a life so full of usefulness in so many 
varied fields should be stricken down when 
hardly beyond its prime ; we only know that 
"God's finger touched him and he slept." 

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THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 

PRICE $1.00 PER YEAR 



Contributions invited from the Alumni of the University. 
Business Address, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter. 



Vol. V 



BALTIMORE, MD., JULY 15, 1909. 



No. 5 



MEDICAL ETHICS. 

An Address Delivered Before the University of 

Maryland Medical Association 

By Samuel C. Chew, M. D., LL. !>., 

March 16, 1909. 

The subject of Professional Ethics is not in- 
cluded in our curriculum for undergraduates, nor 
has it a place in the post-graduate course of which 
it might properly form a part; and yet it is 
worthy of attention as having an important hear- 
ing upon our professional duties. 

Let us first consider what is meant by the term 
Ethics. The meaning of a word is often best 
ascertained by studying its etymological origin, 
and, although many words may have wandered 
by a sort of evolutionary process, as it were, from 
their first signification, yet the tracing of the 
gradual changes may he interesting and may show- 
how the real and full meaning has been acquired, 
and sometimes how it has been lost. 

The word Ethics is derived from the Greek 
«#°s, or ^#05, which are close of kin, and 
though not precisely alike they have a common 
origin, «0os meaning a custom, usage or habit 
and »|0os meaning primarily an accustomed 
seat, whether an abode of men or a haunt or lair 
of beasts to which they resort, and thus later 
coming also to signify custom or habit, and from 
this, disposition and character as formed by habit. 
Both words are perhaps traceable to e£o//.ai ( to 
sit, and thus related to the Latin sedeo, and prob- 
ably through a remote common ancestry of the 
Indo-European stock to the English sit. Now, 
as habits of thought, temper or morality tend to 
form character, it can be seen how the subject of 
Ethics embraces the consideration of the things 
that tend to good. 

But it may be said that though good habits 
tend to form good character, yet bad habits form 
bad character, and why, then, should the term 
Ethics, when used absolutely and without quali- 
fication, relate to the influences which form good 
character, ethical meaning what accords with pro- 



priety, while what does not so accord is unethical. 
Ethical conduct is proper conduct; unethical the 
reverse. In Bentham's phrase, "Ethics may be 
defined the art of directing men's actions to the 
production of the greatest quantity of happi- 
ness." lie ilocs not connect with it at all the idea 
of unhappiness or of any evil. When it is said 
that ethics is the science of morals, the same 
thought is suggested regarding the words "mor- 
als" and "morality," which originally and etymo- 
logically signified what was good or bad in man- 
ners and practices, hut acquired and kept after- 
wards a good meaning when used absolutely, so 
that morality in a person implies rectitude of 
character and immorality the reverse. 

And thus it would appear that words, like or- 
ganisms, may tend to improve upon their original 
condition and acquire an invariably good mean- 
ing which they had not at first, and it may be 
shown that, like organisms, they may undergo a 
process of degeneration. Happily, the words 
"Ethies" and "Ethical" have attained and kept 
a good ining and are restricted to such mean- 
ing when used in reference to conduct or charac- 
ter. 

And here take that very interesting word cliar- 
nctcr itself, which originally and etymologically 
ms a neutral signification either good or bad, as 
modified by adjectives, and yet when used abso- 
lutely and by itself has generally a good sense, 
so that when we speak of a man of character we 
mean a man of good character. Trace for a mo- 
ment the family history of this word character. 

It comes from the Greek, x a P aKT VP an instru- 
ment for marking, and that from x a P^ <TO ' u> , 
to sharpen, which itself, so philology tells us, is 
akin to our homely word scratch. It would seem 
a far cry from a scratch to a character, and yet 
the passage from the one to the other can be 
traced along the devious Indo-European path; a 
path which, though arid to some, may at times 
Je found full of delightful surprises. For the 
instrument, the X a P aKT1 ip makes markings and 
thus impresses qualities or distinctive charac- 



84 



THE HOSPITAL BULLETIN 



teristics, and the best of these survive when the 
word is used absolutely and form a good charac- 
ter, a thing that is marked with good. Now take 
some instances of degeneration in words, as show- 
ing how they may lose their good meaning and 
get a bad one. In early English and down to a 
comparatively recent time the word temper was 
used to indicate governance of disposition or re- 
straint of excitability, so that one engaged in a 
quarrel or a controversy was said to display tem- 
per if in reply he governed his tongue or his pas- 
sion. This proper use showed the origin of the 
word from the Latin temperare, to be moderate, 
to restrain one's self, and it is illustrated by a 
line from Pope : 

"Teach me, like thee, in various nature wise, 
To fall with dignity, witli temper rise." 

But now the very opposite meaning prevails, 
and one who gives way to angry passion is said 
to show a great deal of temper, the word having 

undergone a degeneration from its former g I 

meaning. 

Another instance of such degradation is found 
in the word "nervous," derived from the Latin 
nervosus, itself from nervus, which in classic Latin 
did not mean a nerve hut a sinew, and stood for 
strength and vigor, and hence the English word 
meant '"well-strung," "strong," "vigorous," and is 
illustrated by another line of Pope's: 

"What nervous arms he boasts: how linn he 
treads." 

But now the meaning is in common speech often 
reversed, though this is hardly sanctioned by good 
writers, and the word is used to indicate a condi- 
tion of weak or irritable nerves. And yet I do 
not think that Dr. Johnson is altogether fair in 
referring to this use as belonging to what he 
calls "medical cant," for educated physicians do 
not employ the word nervous in this way either 
in writing or in speech. It is, of course, proper 
to speak of the "nervous system" and of "nervous 
centres," for that is a legitimate use of the word, 
indicating a system composed of nerves or cen- 
tres composed of nerve cells. And yet the fre- 
quency with which the word "nervous" is used to 
connote a lack of nerve control shows a degrada- 
tion from its proper use. 

And now, going hack to words which have ac- 
quired and retained a good meaning, we find that 
the terms "Ethics" and Ethical" relate to the 



practice of those customs or usages which are 
right and proper and thus belong to good charac- 
ter. 

Now the subject of medical ethics, or the con- 
dition of things in our profession which is in 
accordance with proper courtesies and proper char- 
acter, may be considered under two heads: 

first — The ethics or proper courtesies to lie 
observed towards our professional brethren and 
as regulating our relations with them: and 

Secondly, the ethics or proper courtesies to be 
observed towards the community at large, and 
especially those who apply to us for professional 
counsel. 

Under the first are to lie considered the claims 
which physicians as such have upon each other. 
One of these is the claim, for so it may be called 
as being fixed by usage, for professional attend- 
ance without remuneration, which springs partly 
from the esprii de corps, the spirit which should 
govern physicians as belonging to the samebrother- 
hood : and such attendance is customarily given 
also to those members of a physician's immediate 
family who are dependent upon him, but not fur- 
ther. There may be exceptions to this rule, as 
in the case of wealthy physicians, especially 
where the wealth is not the result of professional 
Labors, hut has come from outside sources. But 
even then it is most in accordance with the spirit 
of our calling that the demand should not be 
made nor the expectation shown, but that the 
subject should he left to the beneficiary's own 
sense of justice, when, if remuneration be ten- 
dered, it need not lie refused. Again, if services, 
especially when they have been of an exacting 
character and have consumed much time, have 
been rendered to a physician who at his death 
should have left a large estate, it would be en- 
tirely proper to render an account against the 
estate: for the usage of professional courtesy is 
personal, terminating with death, and does not 
exist as to a family who are wealthy and who have 
no claim of courtesy against the attendant. The 
case is wholly different where a family are left 
with only narrow or moderate means; but that 
rests rather upon grounds of humanity than of 
courtesy. 

In general the claim for service on the part of 
one physician upon another continues when the 
recipient is permanently incapacitated by age or 
sickness, but if the medical profession is aban- 
doned for some other the claim, of course, ceases 
to exist. 






THE HOSPITAL BULLETIN 



85 



Another ground upon which the usage of free 
professional services may rest is that of reciprocity, 
for what is gratuitously rendered should be gra- 
tuitously returned: "Freely ye have received, 
i reely give." 

Another ethieal subject as between physicians 
relates to conduct in consultations. These art- 
held in general for one or other of two reasons — 
the first when a young practitioner from inex- 
perience really needs assistance; the other in 
specially important and gra>ve eases to share and 
divide responsibility, or because of a natural de- 
sire on the part of the patient or his family for 
more opinions than one. In either case the con- 
sultant, if he find an error in diagnosis or treat- 
ment, should feel bound in ethics to protect bis 
colleague's professional reputation and ''to hide 
the fault he sees;" and this can always be done 
without violation of truth. 

The consultant who suggests a change of treat- 
ment which he knows to be needless is chargeable 
with dishonesty, and wit!) the desire of having 
it thought that he knows more than he really does. 
He is as one who 

"Hints a doubt and hesitates dislike, 
Willing to wound and yet afraid to strike." 

Secondly, as regards the relations held to the 
general community, it may be said in passing that 
such matters as gratuitous professional services to 
ministers of religious bodies because of the work 
in which they are engaged, or to the poor on ac- 
count of their poverty, are not properly ethical 
and do not belong to the subject of ethics, but 
rather to that of humanity, and every individual 
case must be considered upon its own merits. I 
would only refer in this connection to a saying 
of the wise and good Dr. Fothergill, that the poor 
were his best patients because the Lord was the 
paymaster. 

An important question in our relations with the 
general public is that of the obligation to secrecy 
as to subjects of which we have knowledge only 
as physicians through professional confidence. I 
believe that the clergy are protected by law against 
compulsion to reveal things which they have 
learned through the confessional, and some moral- 
ists hold that they are justified in disavowing all 
knowledge thus obtained ; that it is simply as 
though it were not known. A story is told of a 
priest to whom the crime of murder had been 
formally confessed, and when in a subsequent con- 



versation bis penitent began to speak of the case, 
"Stop!" said the priest; "do not say a word; this 
is not the confessional, and should I be called 
as a witness anything that you may now say 1, 
could be compelled to reveal." Now- it may be 
belli that the like protection should be given to a 
physician who as a physician has learned things 
which it would be to the injury or the discredit 
of his patient to have disclosed. I do not know 
whether any such ease has been ruled upon. 



RENAL CALCULUS. 

.1/; Address before the Doctors' Class at the Uni- 

versity Hospital on January 29, 1909. 

Hy Randolph Winslow, A. M., M. D. 

CAUSES. 

Tin' causes of urinary calculus wherever it may 
li located are both constitutional and local. Stones 
in the kidney arc generally dependent upon some 
constitutional dyscrasia, whilst those in the urinary 
bladder are frequently due to local conditions. 
Normally the the inorganic salts are held in solu- 
tion in the urine, but when the urine becomes 
too highly concentrated or of too great acidity 
crystals are formed, which may lodge in some 
portion of the urinary tract and by accretion be- 
come calculi. The constitutional conditions that 
most frequently are productive of stone are gout, 
rheumatism, impaired digestion, improper food 
and unhygienic modes of life, whilst the local 
causative factors are foreign bodies, obstructive 
lesions of the lower urinary channels, such as 
stricture of the urethra and hypertrophy of the 
prostrate gland, with infection of the bladder 
Renal calculus naturally depends upon a consti- 
tutional rather than a local cause in the vast ma- 
jority of eases, but in a few instances foreign 
ho.lies have become lodged in the kidney and have 
been the nuclei of stones: thus, a case is recorded 
in Dennis' System of Surgery, where a needle, 
which had been swallow T ed many years previously, 
had found its way into the kidney and had become 
encrusted with salt. It would be quite possible 
that bullets, spicules of bone or other foreign bod- 
ies might in some instances become lodged in the 
kidney and form calculi. 



86 



THE HOSPITAL BULLETIN 



VARIETIES. 

There are three great varieties of calculi — the 
uric acid and water, the oxalate of lime and the 
phosphatic — but they seldom consist of one salt 
and arc usually mixed in composition. Rarer 
forms of calculi are the calsium carbonate, cystin, 
Xanthin and indigo. Renal calculi are generally 
of the uric acid or oxalate of lime varieties, but 
when infection of the pelvis occurs phosphatic 
stones are liable to form or to encrust stones of 
other varieties, if they have already formed. 

COMPOSITION OF CALCULI. 

Nearly all calculi consist of a nucleus and con- 
centric rings of crystaline deposition. The nu- 
cleus may be of a different composition from the 
hulk of the stone; thus, it may be of uric acid, 
whilst the rest of the concoction is calsium ox- 
alate or prosphates. Foreign bodies wherever 
Lodged in the urinary passages will always be- 
come surrounded with salts and will be the nu- 
clei of stones. Crystalization also occurs around 
clumps of bacteria, blood clot, mucus and some- 
times animal parasites, hence at times the stone 
is hollow and without any apparent nucleus. I 
here exhibit a small stone removed from the kid- 
ney by me, which appears to be hollow and with- 
out a nucleus. Uric acid and oxalate of lime cal- 
culi form in acid urine, whilst those of the phos- 
phates are found in an alkaline urine. 

Uric acid calculi are densely hard, smooth or 
slightly rough and yellowish or brownish in color; 
oxalate of calcium stones are known by their very 
rough or tuberculated appearance, hence are called 
"mulberry'' calculi from their supposed resem- 
blance to a mulberry. They are also very hard, 
Phosphatic calculi are generally soft, friable and 
white and are found associated with an alkaline 
urine. 

The calculi may be located either in the kidney, 
ureter or bladder, but the majority of them have 
been formed primarily in the kidney and have 
passed downwards and lodged in the ureter or 
bladder. Renal calculi vary in shape, size and 
consistence and may be single or multiple. They 
may be smooth or rough; frequently they are 



branched like coral, and often assume the shape 
of the renal pelvis, with branches projecting into 
the infundibule calyces. 1 here exhibit a large 
stone shaped like the pelvis of the kidney, with 
those smaller concretions that I removed from a 
woman some years ago. Kidney stones are usually 
small or of moderate size, but sometimes they as- 
sume large proportions, and instances are record- 
ed where they have weighed as much as 19 ounces. 
As these calculi usually are of the uric acid or 
calsium oxalate variety, they are hard and rough 
and do damage to the renal structure. When 
infection has occurred and a phosphatic deposition 
has taken place, the stone may be soft and friable. 
The stone may he single, or there may be a great 
number of them ; often one will be found in each 
calyx. 

I wish at this point to revert to the anatomy 
of the kidney, which is incorrectly described in 
many text-books. In most cases the calyces do 
not empty into the pelvis of the kidney directly, 
but into upper and lower infundibula, or long, 
narrow channels which unite to form the pelvis 
outside the sinus of the kidney, hence there may 
be calculi in each calyx or infundibulum, possibly 
not in the pelvis at all. When the pelvis becomes 
distended it may form a large cavity within the 
kidney and may be the seat of a large stone or 
stones. One or both kidneys may be the seat of 
calculus, and if one is involved the other kidney 
is also very liable to become involved. It is prob- 
able that the disease is bilateral in from 13 to 15 
per cent, of all cases. 

GEOGRAPHICAL DISTRIBUTION. 

Whilst urinary calculus is sufficiently common 
in most parts of the world, it is much more fre- 
quent in some countries than in others. It is 
of especial frequency in India, China and Egypt, 
and surgeons practicing in those regions acquire 
enormous experience in the treatment of this dis- 
order. It is more common in some portions of a 
country than in other parts of the same country, 
and different races living in the same region differ 
in their susceptibility to the disease. In this part 
of the United States it occurs not rarely, but not 



THE HOSPITAL BULLETIN 



87 



so frequently as in some other parts, and it is less 
frequent in the negro than in the white race. 
Why it forms at all, and why it occurs more fre- 
quently in one locality than in another, is a mat- 
ter of surmise, but not of demonstration. 

PATHOLOGY. 

A calculus in the kidney is bound to set up 
more or less nephritis, if the stone is fixed and 
does not change its position then irritation and 
inflammation will be less than if it is movable. 
K the kidney remains aseptic, there may be but 
little pathological damage to the organ, but when 
infection occurs, as it usually does, either from 
the blood stream or by retrogression from the 
bladder, pyelo-nephritis and pyo-nephrosis are the 
natural consequences, and destruction of the or- 
gan and loss of life are by no means uncommon 
sequences. 

SYMPTOMS. 

In the absence of infection a calculus may re- 
main latent, and give rise to no symptoms, or 
to but slight and vague uneasiness. Generally, 
however, irritation and inflammation of the kid- 
ney will take place to a sufficient degree to call 
attention to the fact that some pathological pro- 
cess is in operation and to suggest the suspicion 
that it may be the result of nephrolithiasis. 

The kidney is only palpable, unless it has be- 
come distended and displaced from pyonephrosis, 
hence we but seldom can feel this organ. In 
some cases of very large calculus, the kidney may 
be felt. 

Pain is the symptom which is most constant 
and which first attracts the attention of the pa- 
tient to his disorder. This pain is a variable 
symptom, since it may be slight if the stone is 
fixed, whilst it may be very noticeable if the con- 
cretion is movable and readily changes its posi- 
tion in the pelvis of the kidney- The pain may 
ladiate downward along the course of the ureter, 
when small particles gain entrance into this tube 
and cause nephritic colic, but generally the pain 
is an ache in the kidney itself, which may he 
intensified by pressure on this organ as well as 
by exercise or any jolting. Blood in the urine 
can usually be found in cases of renal calculus, 
either in sufficient quantity to cause a distinct 
coloration of the urine, or by a microscopic ex- 
amination. The hemorrhage is seldom marked, 



as it sometimes is in tuberculosis and malignant 
conditions of the kidney. Pyuria is absent in 
those cases in which infection has not occurred, 
whilst it is very evident when pyelo-nephritis and 
pyo-nephrosis have developed. In all cases there 
will be some increase in the white blood cells as 
seen under the miscroscope. Vesical irritability 
is a frequent sign of renal calculus, and often 
the bladder symptoms predominate over those ref- 
erable to the kidney. Increased frequency of 
micturition with pain may be the most evident 
symptoms. If the urine is acid, and contains 
blood or pus, even though the symptoms are such 
as to call attention to the bladder, it is probable 
that the trouble is located in the upper, rather 
than in the lower, urinary tract. Anuria may 
in rare cases occur, either from a blocking of 
both ureters by calculii, or by reflex action. I have 
a small concretion which caused reflex anuria, 
and gave one much anxiety until it passed, when 
the urinary flow was promptly re-established. 
The passage of concretions will of course serve 
to direct attention to the kidney, but these are 
not often present in the urine. Digestive dis- 
turbances are often associated with nephrolith- 
iasis, such as nausea, vomiting and impaired di- 
gestion. 

The symptoms already mentioned are not suffi- 
ciently characteristic to warrant a positive diag- 
nosis of calculus, as they may be caused by very 
diverse conditions, but they are highly sugges- 
tive. We have, however, at our command other 
methods of investigation, from which very posi- 
tive information may at times be derived. The 
most important and valuable means of diagnosis 
possessed by us at this time is the radiograph, 
which when showing a positive shadow is diag- 
nostic in the highest degree, but the absence of 
a shadow does not indicate certainly that a stone 
is not present; neither does the presence of a 
shadow indicate unerringly that a stone is pres- 
ent. 

When symptoms of irritation of the bladder 
do occur, especially when associated with acid 
urine, a eystoscopic examination should be made, 
and if the bladder walls appear to be healthy, 
with perhaps a redness and pouting of one or 
both ureteral orifices, the trouble is higher up 
in the urinary tract. Catherization of the ureters 
will also give valuable aid in determining the 
nature and location of the trouble. At times 



88 



THE HOSPITAL BULLETIN 



the introduction of a wax-tipped ureteral bougie 
will indicate the presence of a stone in the pel- 
vis (if the kidney or ureter, by means of the 
scratches that may be found on the polished sur- 
face of the bougie. 

Prom what has been said it is evident that 
the symptoms of nephritic calculus are. in most 
instances, not diagnostic, and it is only by a 
careful examination of their phenomena that 
an approximately correct interpretation of their 
meaning may be obtained. 

TREATMENT. 

When a calculus has formed in the kidney, there 
is no known means for its removal, except by a 
surgical operation. The administration of drugs 
may at times alleviate the symptoms, but the 
stone remains. It is necessary therefore to ex- 
pose the kidney, incise its cortex, and remove 
the concretion, or in some cases it may be more 
convenient to open the pelvis of the kidney and 
extract the stone through this incision. Ordi- 
narily it is better to make the incision through 
the vascular kidney, as healing is more certain 
and rapid than when the pelvis is incised. As 
a rule, it is better and safer to employ the lum- 
bar route, though sometimes it will be neces- 
sary to reach the kidney by a transperitoneal op- 
eration. Usually the incision is placed in the 
loin, either in an oblique or perpendicular direc- 
tion, the muscles are divided or a separation of 
their fibres made by blunt dissection, the pos- 
terior lamella of aponeurosis divided ami the peri- 
nephric fat exposed and pushed aside, when the 
kidney is exposed to view. This is separated 
from its connections and forced into the wound 
or it may lie brought out upon the back of the 
patient. The renal vessels are grasped with the 
fingers or a padded forceps, to prevent hemor- 
rhage, and an opening made through the kid- 
ney substance and the stone or stones grasped 
in forceps and removed. Sometimes it may be 
necessary to crush the stone, before it can be re- 
moved from its bed. Any small fragments may 
be removed by irrigation. If the kidney is in- 
fected, drainage by means of tube and gauze must 
be employed ; if it is not infected sutures of cat- 
gut are passed entirely through the organ and 
the wound in the kidney closed. The external 
incision is sutured except for a space large enough 
to permit the placing of a small drain down to 
the kidney. Rapid healing generally ensues, with 
relief of the distressing symptoms. 



REPORT OF A CASE OF UNDESCENDED 

TESTICLE OF THE PERINEAL 

VARIETY. 

By J. Ernest Dowdy, '09, 

Senior Medical Student. 

Before reporting this case, we may refresh our 
memory regarding the steps in the descent of 
a normal testicle. 

The testicles are developed from the genital 
ridge of the Wolffian body. The Wolffian duct 
becoming the vas. The testes in early intra- 
uterine life lie extra-peritoneal and just below 
and in front of the kidneys. 

In their normal descent they pass into the in- 
guinal canal during the seventh month id' ges- 
tation and into the scrotum during the eighth 
mouth. 

They may be arrested at any point in their 
descent or may take an aberrant direction and 
be found lodged under the skin of the abdominal 
wall, the thigh or perineum. One or both tes- 
ticles may fail to follow the normal course and 
may lie retained, in the abdomen, or in the in- 
guinal canal. The causes which operate to pre- 
vent this normal descent of the testicles are ob- 
scure. It may be accounted for, however, by as- 
suming that the external ring is of too small a 
size to allow the testicle to pass through it. or 
that the vessels accompanying the spermatic cord 
are too short to allow the cord itself to be 
stretched sufficiently to allow the testes to reach 
the bottom of the scrotum. 

The wearing of a truss on account of a hernia 
in cases where the descent of the testicle has 
been delayed after birth may also prevent the 
testes from arriving at its normal place in the 
scrotum. 

The causes of cruro femoral and perineal ectopy 
arc still more obscure. It is -thought, however, 
that an over development of certain bands of the 
gabernaculum will have the effect of drawing the 
testes to one side and thus occasion the aberrant 
course. The result of ectopy is impairment of 
the growth and development of the testis, so that 
it remains undersized, but probably possesses the 
] mwer of forming spermatozoa, unless the struc- 
ture is destroyed by attacks of inflammation, 
which are very liable to occur. After the tes- 
ticle has been disorganized sterility of course fol- 
lows. 



THE HOSPITAL BULLETIN 



89 



Bilateral retention does not interfere with de- 
velopment, for the subjects of this misfortune 
have all the characteristic appearance of the male 
sex. and in no way differ from their brothers 
(except they are not capable of procreating their 
species) . 

In unilateral retention there is little to be 
anxious about, for one perfect testicle will suffice 
for the development and procreation of their 
species. 

Complicating maldescended testes very often 
is hernia, and especially is this true if the tes- 
ticle lies in the inguinal canal, as it may inter- 
fere with the wearing of a truss, so that strangu- 
lation of the hernia is very liable to occur. The 
testicle when not lying protected by the thighs, 
in the scrotum, is very liable to be struck and 
bruised, and the ectopic testicle rarely escapes 
several attacks of traumatic inflammation. It 
may also be the subject of gonorrheal inflamma- 
tion from extension of a gonorrhea from the 
posterior urethra. 

Malignant disease is very apt to occur in ec- 
topic testicles, and is predisposed by attacks of 
inflammation to which the testicles in this sit- 
uation are so liable when the malignant disease 
does involve this form of undiscovered testicle 
it almost invariably proves fatal, death taking 
place in usually the short space of one year. The 
sarcomatous variety of tumors is the most com- 
mon. The perineal variety of maldescended tes- 
ticle was first described by Hunter in 1786 and 
afterwards by Curling in 1811, the subject has 
received very little attention by surgical writers 
however. Curling was the first to give a de- 
tailed description of the condition in 1857, and 
a report of nine collected cases. He was also 
the first to treat the condition by operation. The 
patient was an infant four weeks old, and the 
results of operation was unfortunate. Goodanl. 
in 1857 and 1860, reported two interesting cases, 
one in a man 56 years of age and another 22. 
The first case was originally an inguinal ectopia, 
which after the wearing of a bandage for a con- 
siderable time, became perineal, the second was 
cruroscrotal ectopia. 

Amiandale, in 1879, was the first to report a 
ease successfully treated by surgical interference. 

Monods Scvillon, in 1889, collected 30 cases 
of perineal ectopia, which number Weinberger, 
in 1899, increased to 65. 



Adding to this the more recent collection by 
Klein there are 81 cases up to date. 

As to the frequency of perineal ectopia Remies 
and Marshall report only 17 cases in 1-1,400 re- 
cruits examined for miliary service, but not one 
of these is stated to be perineal. 

Godanl, in 53 cases of ectopia, found only 
three examples of perineal variety. 

McAdam Ecclos, in his work on imperfectly 
descended testes, stales that out of 936 instances 
of imperfect descent of the testes, associated with 
hernia, only five were found to be perineal in 
variety. At the Hospital for Ruptured and Crip- 
pled Children in Xew York there have been ob- 
served during the past 18 years 737 cases of un- 
descended testes, and of these only 15 were of 
the perineal variety. 

As regards the age of the patient while the 
disease is of congenital origin, the testes are not 
always found in the perineum at birth. In cer- 
tain cases it is situated just outside of the in- 
guinal ring, or has passed below the pubic bone 
ami later on reaches the perineum In a great 
majority of cases the condition is unilateral. 

Cases have been reported of the condition be- 
ing found in both father and son. 

The case coming into the Genito Urinary De- 
partment of the University Dispensary gave the 
following history: A young white man 17 years 
old, well developed and healthy in appearance, 
but complaining of a dull pain in his testicles, 
which had been present for past four or five days, 
and he attributed it to an injury received while 
carrying a tray in a baker shop. On examina- 
tion the left testicle was found normally de- 
scended into the scrotum. The right testicle could 
he distinctly felt in the perineum, located about 
an inch anterior to the margin of the anus, and 
half inch to the right of the median raphe. It 
was freely movable, and was about the size of 
a walnut. The condition had been present since 
birth and had caused him no inconvenience un- 
til receiving the injury a few days before. 

No other members of his family are suffering 
with the same condition. His father has had an 
oblique inguinal hernia since childhood. An op- 
eration was advised, but the patient refused. 



90 THE HOSPITAL BULLETIN 

ANNUAL REPOKT OF DEMONSTRATOR As a result of the efforts of the Anatomy Board 

OF ANATOMY, UNIVERSITY to curtail the number and extent of autopsies upon 

OF MARYLAND. subjects destined to become the property of the 

By J. W. Holland, M. D., Demonstrator. Board, the material on the whole was somewhat 

Faculty of Physic, University of Maryland: better than in previous years. There has been 

I have the honor to submit the following re- fewer autopsies and less mutilation by post-mor- 

port of the laboratory of practical anatomy for teul operations than usual. 

the session of 1908-1909. It was decided by the Board at its last annual 
students engaged in laboratory. meeting, in November, 1908, to destroy all sub- 
Medical — jects which had been extensively mutilated by 
Second year 48 post-mortem operations, thus avoiding the ex- 
First year 57 pense of embalming and storing such material. 

Advanced, Medical 2 It was also decided to allow deduction of the 

Post Graduates, Medical 8 price of all subjects, among those allotted to the 

Second year Medical (Extra Work) 5 various medical colleges to be used in 1908-1909, 

which proved to be very extensively mutilated by 

Total number of Medical Students 120 post-mortem examination. 

The supply of material distributed from the 

Dental — First and Second year 49 storage plant by the Anatomy Board during the 

Advanced Dental 1 session of 1908-1909 was ample for all purposes. 

Only two fresh subjects were delivered directly 

Total number of Dental Students 50 to the laboratory and these were obtained for 

special use. 

Total Medical and Dental 170 The work ()f th(? ^ mnA year me dical class was 

failed to accomplish required work. very satisfactory and gratifying, there being but 

Medical— one f a ii ure . 

Second year 1 Qwing to &e limited capaeitv of the laboratory 

irs year ag wg jj ag ^ e sma ]i number of demonstrators it 

en a is necessary that the dental class completes its 

_.,„.-, .,„ work before the first year medical class can he- 
Iota! failures lo . , . . . 

gin work. During the last session it was found 

„,-„.'., impossible to have the first year medical class be- 

JV1 A 1 sit K 1 A J-j . 

-r, . , , . 1(mQ 10 „ Q , Q gin work before February 15th, and though the 

Received during 1908-1909 48 ,.-,-,. 

•c a , class continued dissecting till the close of lectures, 

JBrom Storage — ° 

Whole subjects 48 * nere was no * enou g n time to accomplish as much 

Cut subjects 12 as should be expected of this class. 

Received Fresh — Whole subjects 2 One result of this abridgement of first year 

Left from Session of 1907-1908 11 work is to crowd the second year laboratory work. 

The whole session is now required in the second 

Total 73 year to complete the course. 

It is gratifying to note that eight post graduate 

Distributed during 1908-1909— +,,a„,+a ™™ ° i ■ , - , . 

™ ,.- -.. , o,, -, ™ students were engaged m practical anatomy dur- 

To Medical Students 29 . ,, . ° , , , , 

m _, , , „ , , -, .-, m & tne session, i lve second year students demon- 

To Dental Students 12 . n , , , , , , 

„ , n • i o a strafed commendable zeal by devoting their en- 

For demonstrations in Practical Surgery. b . . J b 

To Professor of Anatomy 2 llre Cllristmas vacatlon *> extra laboratory work. 

To Post Graduate Students 6 Nineteen complete sets and many odd bones were 

Unfit for use 7 P re P are( l during the session. These have been 

Left from 1908-1909 11 added to the museum, where needed, and the bal- 

ance stored for use of students during the next 

Total 73 session. 



THE HOSPITAL BULLETIN 



91 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

EDITED BY 

A COMMITTEE OF THE HOSPITAL STAFF 



PUBLISHED BY THE 

HOSPITAL BULLETIN COMPANY 
University of Maryland 



Business Address Baltimore, Md. 

Editorial Address, .... University of Maryland 

Baltimore, Md., July 15, 1909 

CHANGES IN THE FACULTY OF PHYSIC. 

In consequence of the resignation of Prof. S. C. 
Chew from the Faculty of Physic it has become 
necessary for the Faculty to make the following 
changes in its body : 

Prof. C. W. Mitchell has been elected to the 
chair of Professor of Medicine and Diseases of 
Children, thus consolidating the two chairs. 

Prof. Mitchell graduated in the class of 1881 
and has been closely associated with the educa- 
tional work of the University since his graduation. 
In 1896 he entered the Faculty and Board of 
Pegents as Prof, of Therapeutics, Diseases of Chil- 
dren and Clinical Medicine. He served as Dean 
of the Faculty for several years. Prof. Mitchell 
has been regarded by his colleagues and by the 
student body as an able, industrious and popular 
teacher. His loyalty and devotion to the Uni- 
versity of Maryland have been tested on many 
occasions and never found wanting. As a teacher 
he has made good on all occasions. In character, 
scholarship and attainments he is a worthy suc- 
cessor of Nathaniel Potter, Elisha Bartlett. Wm. 
Powers, Samuel Chew, Richard McSherry and 
Samuel C. Chew, the distinguished men who have 
tilled the chair of medicine from the organization 
of the University to the present time. 

Prof. Arthur M. Shipley has been elected a 
member of the Board of Regents as Professor of 
Therapeutics and Surgical Pathology. 

Prof. Shipley graduated in the class of 1902 
with the highest honors of his class. For some 
four years he was Medical Superintendent of Uni- 
versity Hospital, where his work was marked for 
its thoroughness and ability. 

Among the younger graduates of the University 
Prof. Shipley stands out as a man of distinguished 
promise and of rapid advancement. He combines 
all the elements of the teacher, clinician and scien- 
tific worker. 



Prof. Harry Adler, of the class of 1895, has been 
elected Professor of Clinical Medicine and Direc- 
tor of the Clinical Laboratory. After graduation 
Prof. Adler spent several years in post-graduate 
study in Europe. Since his return he has been 
associated with the educational work of the Uni- 
versity, in which he has shown splendid qualifica- 
tions as a teacher and scientific worker. 

As President of the Hebrew Hospital he has 
made a high distinction as an organizer and ad- 
ministrator, having brought this institution into 
the front rank of our city hospitals. Prof. Adler 
has a wide field for the development of his talents 
in the clinical work of the University. 

Prof. I. J. Spear, class of 1900, has been made 
Clinical Professor of Nervous and Mental Diseases. 
After two years of work in Europe Prof. Spear 
took up this line of work at the University. He 
has made such progress as a teacher that his ad- 
vancement was easily won. Prof. Spear has a 
d'stinsruished career ahead of him. 



OUR MEDICAL LIBRARY. 

At the present writing there are more than nine 
thousand bound volumes upon the shelves due 
principally to the endeavors of Dr. Eugene F. 
Cordell, who, when he assumed control some five 
or more years back, found a nucleus of about four 
thousand volumes uncatalogued and uncarcd for. 
By the assiduity and attention of the librarian 
more than five thousand volumes have been added 
to the collection, so that now this library is the 
second medical library in size in Baltimore, and 
contains many rare old volumes bequeathed by 
the worthies of the years gone by. More than 
sixty current medical journals are upon the tables 
of the library, which is open to our students, 
alumni and members of the faculties. It is housed 
in Davidge Hall in a large, well-lighted room. 
Anybody who wishes to do something for the 
University can materially assist by either giving 
or bequeathing their library to the University. 
He may rest assured that any books donated will 
be well cared for, protected, and accomplish a 
great amount of good. Here is an opportunity 
to do something for the University, occasionally 
donate a modern book or two; place in the hands 
of the students the best literature of the day, and 
you may well feel assured that you have done 
something for your fellow man. 



92 



THE HOSPITAL BULLETIN 



MEDICAL ETHICS. 

In the present issue of The Bulletin will be 
found a scholarly paper on "Medical Ethics," by 
Prof. S. C. Chew. 

The Bulletin knows of no one who can write 
upon this subject with more authority than Pro- 
fessor Chew. During a long and active profes- 
sional life he has observed the highest standard 
of professional conduct in all of his relations to- 
ward his profession and towards the public, and 
has exercised an influence for the uplift of pro- 
fessional education and practice which few men 
have enjoyed. Professor Chew has always stood 
for the highest ideals and aims of professional 
work and now at the close of an active and most 
honorable professional career it is most fitting 
that he should give to his professional brethren 
his views on medical ethics. In treating this sub- 
ject he has presented the fundamental principles 
which should govern the practitioner in his re- 
lations towards his profession and towards the 
public. He has said in terse language all that 
can be said upon this subject, leaving the details 
of professional conduct to the good sense, to the 
morals and to the conscience of each individual 
practitioner. 

In closing with the inspired words — "All things 
whatsoever ye would that men should do to you, 
dc ye even so to them," he has expressed the 
highest type of human conduct ever given to man. 

Long before the dawn of Christianity Buddha, 
in the East, preached the substance of these teach- 
ings to his followers, but it remained for the lowly 
Nazarene to give them a force and moral influence 
which have kindled in the hearts of men a love 
and respect for the grandest of all ethical prin- 
ciples. 

In ancient Greece, the Stoics, Academics, Para- 
patetics and Epicureans gave to their followers sys- 
tems of philosophy which sought to establish the 
highest principles of conduct and to confer the 
greatest degree of happiness upon mankind. 

Pythagoras, Socrates, Plato and Aristotle gave 
an impulse and moral force to the teachings of 
their respective sects, which have had wide and 
commanding influence over the intellectual and 
philosophical culture of succeeding generations. 
Their principles of ethics seem to lack only one 
essentia] idea. The principles of human love and 
brotherhood were smothered under the cloak of a 
moral and intellectual culture which made hap- 



piness the aim of conduct and duty an open 
question for discovery. Cicero, in his Treatise, 
De Oflieiis, addressed to his son Marcus, sums up 
tlie moral duties of mankind in a discourse of 
remarkable intelligence and philosophical grand- 
eur. His ethical teachings, largely borrowed from 
the writings of Panaetius, are so wise and clever 
that modern philosophy has scarcely improved 
them. 

To quote his language, we have the true ethi- 
cal spirit which runs through all his writings. 
"For while many subjects in philosophy, of great 
insight and utility, have been accurately and 
copiously discussed by philosophers, the most ex- 
tensive sc< ms to be what they have delivered and 
enjoined concerning the duties of mankind; for 
there can be no state of life, amid public or pri- 
vate affairs, abroad or at home — whether you 
transact anything with yourself or contract any- 
thing with others — that is without its obligations. 
In the due discharge of that consists all the dig- 
nity, and in its neglect, all the disgrace of life." 

Where can one (ind rules of conduct in closer 
harmony with the golden rule than is here stated? 

Of the more modern teachers of philosophy, 
Dr. Samuel Johnson, in Rambler, gives expression 
to the following thoughts which are so nearly 
related to the highest ethical teachings that they 
should he considered by all who aim at excel- 
lence in life's great work. 

"It must be strongly impressed upon our minds 
that virtue is not to he presumed as one of the 
means to fame, but fame to be accepted as the 
only recompense which moralists can bestow on 
virtue — to be accepted with complacency, but not 
sought with eagerness. The true satisfaction which 
is to be drawn from the consciousness that we shall 
share the attention of future times, must arise 
from the hope that with our name our virtues 
will be propagated and that those whom we can 
not benefit in our lives may receive instruction 
from our examples and incitement from our re- 
nown." 

The Bulletin voices, it believes, the wishes 
of its readers when it expresses the hope that 
Professor Chew, in the evening of a well-spent 
life, in the enjoyment of a quiet home, in his 
library filled with the world's best literature, will 
find ample lime and inclination to prepare a 
series of articles upon ethical and literary sub- 
jects for the firofession. 



THE HOSPITAL BULLETIN 



93 



ITEMS. 

The last meeting of the Dorchester County 
Medical Society held in Cambridge with Dr. E. 
Eakin Wolff, class of 1809, in the chair, was ad- 
dressed by Dr. C. W. Mitchell. Dr. H. V. Har- 
baughj class of 1907, was admitted to member- 
ship, and upon the motion of Dr. Guy Steele, Dr. 
C. W. Mitchell to honorary membership. 



Dr. Salvatore Deniarco has returned from East 
Orange, N. J., where he was called to operate 
upon a case of appendicitis. 



Doctor and Mrs. Gordon Wilson have returned 
from their honeymoon and are guests at the Chat- 
tolanee. 



Dr. D. C. Absher, class of 1909, who was op- 
erated upon at the University Hospital recently, 
is reported to be doing nicely and will soon be 
able to be about. 



Dr. William F. Schwartz, class of 1908, for- 
merly resident physician to the insane department 
of Bayview Asylum, has removed to 1200 North 
Caroline street. 



Dr. R. C. Bay, medical superintendent of the 
University Hospital, has been commissioned a 
captain in the medical corps of the Maryland 
National Guard and assigned to the Fifth In- 
fantry. 



Dr. Eugene F. Cordell has returned to the city 
after a fortnight spent at Atlantic City, where 
he attended the meeting of the American Medi- 
cal Association. 



Dr. Frank J. Kirby, class of 1892, delivered 
the principal address to the graduates at the re- 
cent commencement of the St. Joseph's Hospital 
Training School for Nurses. 



Dr. N. E. Berry Iglehart, class of 1889, of 
Baltimore, attended the sessions of the Ameri- 
can Medical Association at Atlantic City. 



Dr. William P. E. Wyse, class of 1886, and 
Mrs. Wyse have returned from a short visit to 
Annapolis. 



Doctor and Mrs. Henry J. Berkeley are sum- 
mering at Magnolia, Mass. 



Dr. Ernest Neale has closed his city home and 
will summer at Ocean City, Md. 



Miss Ruth Kuhn, has resigned the superintend- 
ency of the Atlantic Coast Line Hospital, Way- 
cross, Ga. 



Drs. Hiram Woods and Charles O'Donovan ad- 
dressed a meeting at Centreville, June 9, 1909, 
held to create interest in the proposed hospital 

to be erected in or near Centreville. 



Dr. Charles W. Mitchell, who has been the guest 
of President Woodrow Wilson at his home in 
Princeton, has returned to his home. 



1 >r. A. D. McConachie has been spending a 
fortnight at Atlantic City. 



Drs. L. Gibbons Smart, R. C. Massenberg, J. 
C. Clarke, M. G. Porter, James F. H. Gorsuch 
and J. H. Bates, all of Baltimore county, attended 
the last meeting of the Baltimore County Medi- 
cal Society held at Towson. Dr. J. Clement 
Clarke, superintendent of Springfield Asylum, at 
Sykesville, Md., invited the Society to hold their 
duly meeting at his Hospital. 



Miss Ann Elizabeth Chapman, a graduate of 
the University Hospital Training School for 
Nurses and for several years after graduation in 
charge of the operating rooms at the University 
Hospital, at present superintendent of the Emer- 
gency Hospital, Easton, Md., has been notified 
by the Federal authorities that she passed second 
in the competitive examinations for trained nurses 
for service in Panama, held throughout the coun- 
try in the spring, and has been asked to inform 
them of the earliest date at which she can report 
in New York to be sent to the Ancon Hospital, 
on the Pacific Slope of the Panama Canal Zone. 
Miss Chapman graduated with the class of 1906. 
Miss Mary Hamlin, another of our graduates, has 
been successful in an examination for nurses for 
service in the naval branch of our military or- 
ganization. 



94 



THE HOSPITAL BULLETIN 



Our alumni hold the following positions at the 
College of Physicians and Surgeons, Baltimore : 

Professor of Principles and Practice of Sur- 
gery, Clinical and Genito-Urinary Surgery, and 
Dean of the Faculty — Dr. Charles F. Be van. 

Professor of Medical Jurisprudence and Di- 
rector of the Pasteur Institute — Dr. N. G. Keirle. 

Professor of Obstetrics ami Gynecology — Dr. 
George W. Dobbin. 

Professor of Pathology and Bacteriology — Dr. 
W. Royal Stokes. 

Professor of Anatomy and Clinical Surgery — 
Dr. A. C. Harrison. 

Professor of Clinical Medicine — Dr. Cary B. 
Gamble, Jr. 



Dr. Eugene Lee Crutehfield, fellow and gold- 
medalist of the Society of Science, Letters and 
Art, of London, England, has been elected to a 
fellowship in the American Academy of Medicine. 
This is the most scholarly and exclusive medical 
organization in the United States. 



I)]-. Solomon L. Cherry, class of 1908, has been 
appointed Pathologist to the Hebrew Hospital, 
Baltimore; Drs. Samuel H. Long and Everette 
[seman, assistant resident physicians. 



Dr. J. S. Norman declined the appointment 
as assistant resident physician, Bayview Asylum, 
and Dr. E. P>. Wright received the appointment. 



Dr. Thomas E. Satterthwaite, LL. D., 1908, 
of New York, has been appointed by this Uni- 
versity a delegate to the 350th anniversary of the 
Foundation of the University of Genoa. 



Dr. E. W. Pressly, class of 1887, of Glover. 
S. ('., has been in poor health for over two years. 
Recently he experienced a slight paralytic stroke. 



Dr. Nathan YVinslow, class of 1901, has been 
elected managing editor of the Maryland Medi- 
cal Journal. 



Dr. E. G. Ballenger, class of 1901, is editor 
of the Record and Journal of Medicine, published 
at Atlanta. Ga. 



at Salisbury, Md., has resigned to take charge of 
the Lelia Morton Memorial Station, at Leesburg, 
Va. The Memorial was established at Leesburg 
by ex- Vice-President Levi P. Morton in memory 
of his daughter, and since its inauguration five 
years ago has employed the services of a trained 
nurse for the benefit of the people of Leesburg 
and vicinity. Miss Wise is a daughter of Mr. 
William X. Wise, of Leesburg. 



Dr. Jacob Wheeler Bird, class of 1907, of West 
River, Md., for the past three years connected with 
the University Hospital, first as resident student, 
then as assistant resident surgeon and during the 
past year with the additional office of assistant 
superintendent, has located at Sandy Spring, Md., 
taking the place of the late Dr. Boger Brooke, 
also a graduate of this school. 



Dr. Frank O. Rogers, class of 1901. spent Fri- 
day, June 2, 1909, in Baltimore. He is the same 
old Frank, as full of fun as ever. He informs The 
Bulletin that Dr. Edward 0. McEachern, class 
of 1901, died recently of tuberculosis; also, of 
the death of Dr. William H. Whitehead, of Rocky 
Mount, N. C, class of 1870, father of Dr. Joe 
Whitehead, class of 1899, also of the same place. 
Amongst some of the other news gleaned from 
him were that Dr. Louis Haines, class of 190*2, 
of Winston-Salem, N. C, has given up medicine 
and taken to the brick manufacturing business; 
that Dr. R. T. S. Steele, class of 1899, of North 
Carolina, has forsaken medicine and removed to 
Pennsylvania, where he has entered the mining 
business. 



Dr. Murray Hollyday, class of 1908, formerly 
resident physician in Church Home and Infirm- 
ary, has been appointed resident physician to the 
Maryland Steele Company, Sparrows Point, Md. 



Dr. Gideon N. Van Poole, class of 1899, cap- 
tain United States Army Medical Corps, has been 
relieved from duty at Fort Slocum, X. Y.. and 
will proceed at the expiration of his present leave 
of absence to Fort Sheridan, 111., for duty. 



Miss Eelen Wise, a graduate of the University Dr. W. E. Wiegand attended the meeting of 

Hospital Training School for Nurses, and su- the American Medical Association at Atlantic 
perintendent of the Peninsula General Hospital City. 



THE HOSPITAL BULLETIN 



95 



Dr. William T. Councilman, class of 1878, Pro- 
Eessor of Pathology in the Harvard Medical 
Scl 1, lias been elected a trustee of the Ameri- 
can Medical Association. 



Dr. George Wythe Cook, class of 1869, of the 
District of Columbia, has been appointed by the 
President of the American Medical Association a 
member of the Committee on Rules and Order 
of Business, and Dr. George Lane Taneyhill, a 
member of the Reference Committee on Legisla- 
tion and Political Action. 



At the meeting of the American Medical As- 
sociation Dr. Fry, of Washington, defended ven- 
tro-suspension, though fixation occasionally oc- 
curred by accident. He objected to the Alexander 
operation owing to the difficulty of isolating the 
ligaments. He thought the Baldy-Webster op- 
eration the best yet described as it so completely 
lifted the prolapsed ovary. 



Dr. Branch Craig, class of 1909, had the honor 
of attending the highest grade before the recent 
examination of the North Carolina State Medical 
Examining Board. The Bulletin takes this op- 
portunity of congratulating and thanking Dr. 
Craig for the credit he has reflected upon his 
Alma Mater. 

We are also glad to report that every candi- 
date from the University of Maryland appearing 
before this Board did us the credit of passing. 



A diploma of honor for an exhibit of superior 



The Maryland Committee for the Prevention 
of Blindness has been organized with our alumni 
occupying the following offices: 

Vice-Chairman — Dr. Hiram Woods. 

Medical Committee — Louis Allen, J. Whit- 
ridge Williams, Hiram Woods, Samuel Theobald, 
Prank Crouch, Herbert Harlan, Guy Steele, L. 
B. ilenkel. Jr., W. F. Hall, Robert L. Randolph, 
R. Lee Hall, H. 0. Reik, J. L. Lewis, James .1. 
Cat toll, 0. M. Linthicum, Marshall Price, G. I. 
Bat wick, H. W. McComas, F. (). Miller, J. (i. 
Selby and P. S. Page. 



Dr. William X. Bisphan, class of 1897, now a 
major in the United States Army, has been or- 
dered from San Francisco to Fort Leavenworth, 
Kan., for duty at the United States Military 
Prison. 



At the annual meeting of the Faculty of the 
Maryland Medical College our alumni were elected 
to the following offices: 

President — Dr. A. D. McConachie. 

Vice-President — Dr. J. W. Funck. 

Dean — Dr. Harry Gross. 

Assistant Dean— Dr. W. S. Smith. 



On invitation of the Nebraska Pharmaceutical 
Association, Dr. Henry P. Hynson, professor of 
the practice of pharmacy in the department of 
pharmacy of the University of Maryland, made 
an address before the Western organization at 
their annual meeting beginning June 15. 



Dr. W. J. Riddick, acting assistant surgeon, 



merit was awarded to the University ot Maryland TT ., , , ,, , , t -, , •, 7 

. ,. ,. ,,. „ .. , * , United States Aavy, has been ordered to dutv at 

at the Atlantic Citv Meeting ot the American . , ,,. , .. ' " . , „ . ' 

., ,. , . ,. the Charleston Navy lard. Charleston, S. C. 



Medical Association. 



Professor Hiram Woods attended the recent Dr " IL K Jenkins, acting assistant surgeon, has 

meeting of the American Medical Association been ordered to duty at the Naval. Hospital, Nor- 
held at Atlantic City. lolk ' ^ a - 



Professor P. Tunstall Taylor is spending a few Dr " Charles IL 0' D °novan « summering 

,,., • -R.--J--,, country place, Wicklow, near Catonsville. 

Lays m noston. ■> r > 



at his 



Dr. William Royal Stokes delivered an address Miss Nettie Flannagan, former superintendent 

to the recent graduates of the College of Physi- of nurses, has accepted the superintendency of 

cians and Surgeons, Baltimore, at their banquet nurses, St. Luke's Hospital, Spokane, Washing- 

at the Hotel Belvedere. ton. She entered upon her duties June 1, 1909. 



96 



THE HOSPITAL BULLETIN 



Miss Augusta Russell, a graduate of the Uni- 
versity Hospital Training School for Nurses, lias 
resigned her position as superintendent of nurses, 
Maryland State Sanatorium for Tuberculosis, 
Sahillasville. 



Dr. Thomas J. O'Donnell, class of 1903, a well- 
known young physician of South Baltimore, has 
been made a police surgeon by the Board of Po- 
lice Commissioners. He succeeds Dr. Rastus Ran- 
som Norris, class of 1904, police physician for 
the First Medical District. Dr. O'Donnell is one 
of the most prominent of the young physicians 
of South Baltimore and is widely known in that 
section. He is a graduate of the medical depart- 
ment of the University of Maryland, and was at 
one time resident physician in St. Joseph's Hos- 
pital. 

Dr. Norris has removed to Crisfield, where he 
will engage in the practice of his profession. 



Dr. Gordon T. Simonson, class of 1896, is lo- 
cated at Crisfield, Md., where he enjoys a large 
and lucrative practice. 



Dr. Joseph W. Holland, class of 1896, has been 
advanced to the position of Associate Professor 
of Anatomy. 

Dr. Clarence E. Collins, class of 1902, is lo- 
cated at Crisfield. 



Dr. W. II. Coulbourn, class of 1901, is Located 

al Crisfield. 



Dr. William D. Cawley, class of 1902, is lo- 
cated at Elkton, Md. 



Dr. Albert Scott Harden, class of 1901, is lo- 
cated at Newark, N. J. 



Dr. Robert Lee Hall, class of 1901, is located 
at Pocomoke City, Md. 



Dr. Frederick William Schlutz, class of 1902, 
of Minneapolis, has sailed for Europe, where he 
will study in the clinics of Germany and Vienna. 



Dr. A. W. Dissosway, class of 1905, of Ply- 
mouth, N. C, recently, while in the city, paid 
the hospital a hurried visit. He reports that he 
i< doing nicely. 



Dr. Ernest Rowe, class of 1906, has located in 
Baltimore, and will devote his entire attention to 
diseases of the nose, throat, eye and ear. During 
the past year he was superintendent of the Bal- 
timore Eye, Ear and Throat Hospital. 



Dr. John R. Winslow has resigned from the 
staff of the Presbyterian Eye, Ear and Throat 
Hospital and has accepted a position upon the 
staff of the Baltimore Eye, Ear and Throat Hos- 
pital. 



Amongst the many, many eulogistic expressions 
anent the resignation of Professor Samuel ('. 
Chew from the chair of medicine was the editorial 
in the Baltimore Sun of recent date, which is 
herewith appended : 

Long and Honorable Career. — The resigna- 
tion of Dr. Samuel C. Chew from the chair of 
the Practice of Medicine in the faculty of the 
University of Maryland severs an association 
which has continued personally and by heredity 
for the greater part of the life of that venerable 
institution. In 1907 the University celebrated 
its centennial. More than eighty years before that 
celebration, when the school of medicine was less 
than twenty years old, Dr. Chew's father, the 
elder Dr. Samuel Chew, who came up from Cal- 
vert county, entered as a student of medicine. 
Fourteen years later he was appointed to the chair 
of Materia Medica, and afterward succeeded to 
that of the Practice of Medicine, which he oc- 
cupied up to the time of his death in 1864. His 
son, the present Dr. S. C. Chew, then went into 
the faculty — first as professor of Materia Medica, 
and then to the chair of the Practice of Medicine, 
which he has just resigned. He has, therefore, 
been a member of the faculty for nearly 45 years. 

In 1907 the University conferred upon him the 
degree of doctor of laws, and in presenting him 
on that occasion Mr. John P. Poe said of him: 
''During a professorship of 43 years thousands of 
students have had the benefit of his luminous and 
comprehensive instruction, and now, with a mind 
of great original force, enriched by the valuable 
stores of a wide and diversified experience and 
strengthened by assiduous cultivation and ripe 
scholarship, he still invigorates the University by 
the fruits of his high character, matured wisdom 
and unusual attainments." 

Dr. Chew succeeded Mi-. S. Teackle Wallis as 
president of the trustees of the Peabody Institute 



THE HOSPITAL BULLETIN 



97 



and still occupies that important place. Few citi- 
zens of Baltimore are better known to the people 
of the city in which he has spent his honorable 
and useful life, or are more generally honored ami 
beloved than Dr. Chew. 



Dr. Irving J. Spear has been elected clinical 
professor of Diseases of the Nervous System and 
Pschiatry. ■ 

President Thomas Fell has been notified by the 
Army authorities that St. John's College, Depart- 
ment of Arts and Sciences, has been designated 
as one of the distinguished military institutions 
of the country, as a consequence of which he 
may designate one of his graduates for appoint- 
ment as second lieutenant to the United States 
Army. No mental requirements are necessary for 
the appointee as a perquisite to his commission, 
hut he must pass the ordinary physical examina- 
tion. 

Dr. John C. Travers, class of 1895, who left 
America six weeks ago to accept a government 
position in the Philippines, writes concerning his 
impressions of Hawaii, where he stopped en route 
to Yokohama, Japan, that he was charmed with 
the equable climate and productive soil of Hawaii, 
as well as the hospitality of the residents of Hono- 
lulu. Of the climate he says: "The combination 
of tropical sunshine and sea breeze produces a 
climate which can be compared to nothing on any 
mainland or to any other island group. Hawaii 
has a temperature which varies not more than 
ten degrees through the day, and which changes 
the year around from 55 to 90 degrees. Swel- 
tering heat or biting cold are unknown, sunstroke 
is a mythical name or an unthought of thing. A 
frost bite is heard of no more than a polar bear. 
Conjure up the memory of the most perfect May 
day, the kind you are probably having at home 
at the present time. A day when sunshine, soft 
airs and the fragrance of buds and smiling Na- 
ture combine to make the heart glad. Multiply 
it by 365 and the result is the climate of Hawaii.*' 
He goes on to say that the fruit packers of Hawaii 
have made fortunes, and there is a bright future 
for those who engage in the industry. Sugar is 
the staple product, the treaty of reciprocity ad- 
mitting sugar free to American markets having 
resulted in so fostering the industry that $100,- 
oiiii.OOO is now invested in it, and still there is 
waste land awaiting cultivation. Doctor Travers 
practiced for many years in South Baltimore. 



The University of Maryland Alumni of the 
American Medical Association held their annual 
meeting at the Wiltshire, Atlantic City, on Tues- 
day, dune 8, 1909. In the absence of the presi- 
dent. Dr. Laurence D. Gorgas, of Chicago, Dr. 
(',. Lane Taneyhill, of Baltimore, vice-president, 
presided. Dr. Arthur Ewens, of Atlantic City, 
welcomed the visitors. The following officers 
were elected : 

President — Dr. G. Lane Taneyhill. 

Vice-President — Dr. A. A. Matthews. 

Secretary — Dr. G. B. M. Bowen, Vernol, Utah. 

Fifty-two sat down to the banquet. Dr. A. 
D. McConachie was toastmaster. Speeches were 
made by Drs. Randolph Winslow, J. S. Hartman, 
1. S. Stone, etc. Those present were: 

1 toctors — 

Harry Adler, 1895, Baltimore. 

Charles Bayley, Jr., 1904, Baltimore. 

Josiah S. Bowen, 1903, Mt. 'Washington, Md. 

G. B. M. Bowen, 1887, Vernol, Utah. 

Frank E. Brown, 1893, Baltimore. 

T. Harris Cannon, 1901, Baltimore. 

Albert H. Carroll, 1907, Baltimore. 

James J. Carroll, 1893, Baltimore. 

Lee Cohen, 1895, Baltimore. 

E. V. Copeland, 1905, Round Hill, Va. 

Eugene F. Cordell, 1868, Baltimore. 

G. Wythe Cook, 1869, Washington, D. ('. 

James M. Craighill, 188'?, Baltimore. 

Andrew J. Crowell. 1893, Charlotte, N. C. 

S. Thomas Day, 1889, Port Norris, N. J. 

Curran B. Earle, 1896, Greenville, N. C. 

Arthur E. Ewens, 1904, Atlantic City, N. J. 

Frank V. Fowlkis, 1887, Burkeville, Va. 

Henry M. Fitzhugh, 1897, Westminster, Md. 

Monte Griffith, 1896, Washington, D. C. 

Jos. E. Gichner, 1890, Baltimore. 

Norton Royce Hotchkiss, 1891, New Haven. Ct. 

Jacob H. Hartman, 1869, Baltimore. 

Albert S. Harden, 1901, Newark, N. J. 

Jos. L. Hirsh, 1895, Baltimore. 

Richard Hall Johnston, 1894, Baltimore. 

Frank J. Kirby, 1893, Baltimore. 

Dorsey W. Lewis, 1896, Middletown, Del. 

Edgar B. LeFevre, 1905, Inwood, W. Va. 

Robert L. Mitchell, 1905, Baltimore. 

Chas. W. McElfresh, 1889, Baltimore. 

Robert A. Moore, 1891, Durham, N. C. 

Alexander D. McConachie, 1890, Baltimore. 

H. E. McConnell, 1890, Chester, S. C. 

T. K. Oates, 1896, Martinsburg, W. Va. 



98 



THE HOSPITAL BULLETIN 



J. N. Reik. 1900, Baltimore. 

Chas. W. Roberts, 1906, Douglas, Ga. 

J. Dawson Reeder, Baltimore. 

W. II. William Ragan, 1874, Eagerstown, Md. 

('. M. Strong, 1888, Charlotte, X. C. 

Earry W. Stoner, 1907, Baltimore. 

[saac S. Stone, 1872, Washington, D. C. 

Frederick Snyder, 1908, Rosendale. X. Y. 

G. Lane Taneyhill, 1865, Baltimore. 

0. Tydings, 1877, Chicago. 

J. S. Turner. 1896, Greensboro, X. C. 

Randolph Winslow, 1873, Baltimore. 

J. S. B. Woolford, 1896, Chattanooga. Tenn. 

Wm. E. Wiegert. 1876, Baltimore. 

E. A. Wareham, 1883, Hagerstown, Md. 



In an oration on ""State Medicine and Hy- 
giene." before the American Medical Association, 
at Atlantic City. June 9, 1909, Dr. John S. Ful- 
ton, of Baltimore, advocated national vital statisti- 
cal laws and condemned the present boards of 
health, which wait for disease to break out be- 
fore taking any action. 

Dr. Fulton also stated that the United States 
had neglected to carry out its agreement with the 
Italian Government to report deaths of Italians 
in this country, and blamed the failure on the 
lack of method of the Federal authorities, who. 
lie asserted, are behind the health departments of 
every other country in the world. 



At the recent examination of the State Board 
of Examiners of South Carolina the following 
graduates of the University of Maryland passed 
the examination: 

(i. C. Bolen, M. D. 

M. E. Brogden. M. D. 
I). A. Bun-ess, M. D. 
W. T. Gibson, M. D. 
J. W. McConnell, M. D. 
L. A. Risor. M. D. 
T. II. Wedoinan, M. D. 
There were no rejections. 



Dr. R. C. Buck, class of 1874, now practicing 
his profession at Garrisonville, Stafford county. 
A a., sent Tin: Bullf.tix the following Program 
of Graduation of his class. It will no doubt be 
lead with interest by the older alumni of the Uni- 
versity. ( >f the class numbering 17 at time of grad- 
uation eighteen are known to be dead. Of the 
Faculty of Physic only two survive — Prof. S. C. 
Chew and Professor Tiffany, and they are not 
actively connected with the present Faculty. The 
Hon. S. Teackle Wallis. Provost, and the Rev. 
Moses D. Hoge, the orator of the occasion, are 
dead. 

Sixty-seventh commencement of the School of 
Medicine of the University of Maryland, held at 
Ford's Xew Opera House, Baltimore, Tuesday. 
March 3rd. 1871. 

President of the class. W. R. Winchester. 

Committees. — Stage Committee (White Badge). 
— Louis A. Weigel, Chairman: James Brown, H. 
T Burgin. W. C. Claude, G. A. Fenton, J. B. 
Galloway, Gabriel Gimenez, W. B. O'Reilly. — 
Orchestra Committee (Blue Badge). — C. E. Cham- 
berlayne. Chairman: W. B. Beach, J. H. Cram, 
.1 (t. Harrington, C. L. Mitchell, R. H. Smith, B. 
F Winchester, R. E. Yoe. — Balcony Committee 
(Blue and White Badge).— F. D. Emack, Chair- 
man; Charles Abert, Jr., J. D. Fiske, E. P. Mc- 
Devitt. T. E. Murrell, William Eawlings, X. C. 
Stephens, L. L. W. Tall. 

Order of Exercises. — Reading of the mandamus, 
by the Dean. Conferring of Degrees, by Hon. S. 
Teackle Wallis, LL. D., Provost of the University. 
Valedictory Address, by Rev. Moses D. Hoge. 

Graduates, 1871. — Howard E. Ames, Maryland : 
Joseph S. Baldwin, Virginia : Martin B. Billings- 
ka. Maryland: John C. Bryce, South Carolina: 
Carey Buck, Virginia: Charles T. V. S. Butler, 
West Virginia: M. S. Butler, West Virginia; C. F. 
Cairnes, Maryland: D. Lewis, Cheatham, Georgia; 
Frank Cockey, Maryland : J. Alvan Dawson, Mary- 
land : Amos P. Dodge, Xew York: Elisha C. Etchi- 
son, Maryland: Wickliffe Frierson, Tennessee; F. 
Denton Gavin, Maryland: J. Edmund Gorsuch, 



Maryland; James W. Gurley, South Carolina; 
Bezin W. Hall, West Virginia; Wm. Nevitt Handy, 
Maryland; H. T. Harrison, Virginia; Alexander 
Hill, Maryland; J. Rufus Humphrey, Virginia; 
J. Lawrence Kelly, Georgia; George S. Kinnemon, 
Maryland; L. Mervin Maris, Maryland; Charles C. 
McDowell, Maryland; Wm. J. McDowell, Mary- 
land ; Edward S. Miles, Maryland; Robert B. Eori- 
son, Maryland; Elisha E. Mullineaux, Maryland; 
H. Eugene Norris, Maryland; George T. Perkins, 
Maryland; Eldridge C. Price, Maryland; (). II. 
Williams Pagan, Maryland ; Wm. M. Eeardon, Vir- 
ginia ; Albert J. Remsherg, Maryland ; Augustus 
Piggs, Maryland; Benjamin S. Roseberry, Mary- 
land; Samuel Rowland, Maryland; Thomas E. 
Sears, Maryland; J. T. Shepherd, Georgia; .1. 
Dawson Smith, Virginia; Benjamin H. Todd, 
Maryland; George W. Wiener, Maryland; J. Mar- 
ion Wilkinson, Maryland; Willard H. Wilson, 
Maryland; Weems P. Winchester, Maryland. 

University of Maryland, Hon. S. Teackle Wall is, 
LL. D v Provost. 

Faculty of Physic. — Nathan If. Smith, M. D., 
President of the Faculty and Emeritus Professor 
of Surgery. William E. A. Aikin, M. D., LL. 1)., 
Professor of Chemistry and Pharmacy. George W. 
Miltenberger, M. D., Professor of Obstetrics. 
Richard McSherry, M. D., Professor of Principles 
and Practice of Medicine. Christopher Johnston, 
M. D., Professor of Surgery. Samuel C. Chew, 
M. D., Professor of Materia Medica and Therapeu- 
tics. Frank Donaldson, M. D., Professor of Physi- 
ology and Hygiene, and Clinical Professor of Dis- 
eases of the Throat, Lungs and Heart. William T. 
Howard, M. D., Professor of Diseases of Women 
and Children. Julian J. Chisolm, M. D., Profes- 
sor of Diseases of the Eye and Ear. Francis T. 
Miles, M. D., Professor of Anatomy, and Clinical 
Professor of Diseases of the Nervous System. Alan 
P. Smith, M. D., Professor of Operative Surgery. 
L. MeLane Tiffany, M. D., Demonstrator of 
Anatomy. 



THE HOSPITAL BULLETIN 99 

MARRIAGES. 

Dr. John Martin Elderdice, class of 1905, of 



Mardela Springs, Md.. was married to Miss Edna 
Adlcins, of Salisbury, dune 2, 1909. 



Dr. Gordon Wilson. Associate Professor of 
Medicine, was married the early part of June to 
Miss Elizabeth Preston Elliott, daughter of Mrs. 
Elliott and the late Warren Grice Elliott, of 2025 
North Charles street, Baltimore, Md. The cere- 
mony was performed in Old St. Paul's ('lunch by 
Reverend Dr. Arthur Kinsolving. A small recep- 
tion for the two families and the wedding party 
followed the ceremony. On their return Doctor 
and Mrs. Wilson will spend the summer at the 
Chattolanee Hotel and in the fall will take pos- 
session (if their new home. PUS North Charles 
street. 



On April 28, 1909, in Amesbury, Mass., Miss 
Annie Cunningham, a graduate of the Univer- 
sity Hospital Training School for Nurses, class 
of 1908, was married to Mr. William MacDonald. 



Dr. J. Edward Benson, class of 1884, was mar- 
ried June 1, 1909, to Miss Laura Taylor, a teacher 
in the Hagerstown schools, at the residence of 
her sister, Mrs. Beachley, wife of School Com- 
missioner Harry K. Beachley, by Reverend Ed- 
win T. Mobray, pastor of St. Paul's Methodist 
Church. Doctor and Mrs. Benson will spend their 
honeymoon in visiting points in the North. After 
their return they will reside at Cockeysville, Md. 



Dr. John R. Abererombie, of Baltimore, was 
married Wednesday, June 13, 1909, to Dr. Anna 
D. Schultze, of Baltimore, daughter of Mr. and 
Mrs. William T. Schultze, also of Baltimore. The 
ceremony was performed at Grace Protestant 
Episcopal Church by the Rector, Reverend Dr. 
Arthur Chilton Powell. Doctor and Mrs. Aber- 
erombie will spend their honeymoon in visiting 



100 



THE HOSPITAL BULLETIN 



] mints of interest in the North. On their return 
they will reside at the Netherelift Apartments, 
82? Hamilton Terrace. 



The marriage of Miss Mary Agnes Browne, of 
Pittsburg, to Dr. Reuben Alexander Wall, class 
of 1904, of this city, took place Wednesday, June 
1(5, 1909, the ceremony being performed by Rev. 
Dr. Van Dyke, Rector of St. Mary's Episcopal 
Church. The groom was attended by Dr. Edgar 
Allen Fleetwood, of Savannah, Ga. After an ex- 
tended wedding trip Doctor and Mrs. Wall will 
bo at home to their friends at Minnifield, Ed- 
mondson and Swan avenues, Baltimore. 



Dr. Walton Hyde Hopkins, class of 1904, of An- 
napolis, was married Wednesday, June 23, 1909, 
tt Miss Lila Holmes Trenholm, a graduate of the 
University Hospital Training School for Nurses 
and daughter of Mr. Glover Holmes Trenholm. 
The ceremony was performed by Reverend Edwin 
Barnes Niver, Rector of Christ Church, at the 
home of the bride, 713 St. Paul street, Baltimore. 
Doctor and Mrs. Hopkins, immediately after the 
ceremony, left for a Northern wedding trip and 
on their return early in July they will go to their 
future home in Annapolis. 



Dr. Harry M. Robinson, class of 1909, was 
married to Miss Verna Beatrice Wilson, at Violet- 
ville, Baltimore county, Md., May 25, 1909. 



DEATHS. 

Dr. James H. Thomas, class of 1851, died at 
his home near Hurlock, Md., June 20, 1909, of 
paralysis. He was nearly 82 years of age. He 
wiis a native of Dorchester county, and the son 
of the late Algernon Thomas. He was graduated 
in medicine from the University of Maryland in 
1851, and practiced his profession for a time at 
Smyrna, Del, but finding farming more conge- 



nial he moved to his splendid farm near Hurlock. 
He is survived by a widow, who was a Mrs. Ed- 
niondson, of East Newmarket, Md. 



Dr. Walter Franklin Fundunberg, class of 1850, 
surgeon of the 176th Pennsylvania Volunteer 
Infantry Regiment during the Civil War, died at 
Atlantic City, November 22, 1908, aged 80. 



Dr. George 0. Johnson, class of 1869, of Fort 
Cobb, Oklahoma, a member of the American Medi- 
cal Association, and a member of the Senate in 
the First and Second Legislatures of Oklahoma, 
died in Guthrie, February 10, 1909, from asphyx- 
iation by natural gas, aged 63. 



Dr. Richard Evans, class of 1886, of Butte, 
Mont., died in a hospital in that city, June 8, 
1909, aged 53. 



Dr. Legare Hargrove, class of 1891, of Nanse- 
mond county, Va., died June 16, 1909, in a Nor- 
folk hospital, aged about 36 years. He is sur- 
vived by a widow, who was Miss Martha Driver, 
and one daughter. 



Dr. Luther Elsworth Zech, class of 1892, a 
member of the Medical Society of the State of 
Pennsylvania and of the borough School Board, 
died suddenly at his home in York, near Salem, 
Pa., from angina pectoris, aged 47. 



Doctor Thomas Perry Robossom, class of 1859, 
died at his home in Flintstone, Md., May 28, 
1909, from paralysis, aged 75. 



Dr. Alexander Harmon McLeod, class of 1866, 
for many years an official of the Cincinnati, Ham- 
ilton and Dayton Railroad, died at his home in 
Wyoming, Cincinnati, May 11, 1909, from pneu- 
monia, aged 63. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 

PRICE $1.00 PER YEAR 



Contributions invited from the Alumni of the University. 
Business Address, Baltimore, Md. 



Entered at the Baltimore Post-ofHce 
as Second Class Matter. 



Vol. V 



BALTIMORE, MD., AUGUST 15, 1909. 



No. 6 



REMARKS OX THE CAilSES AND THE 
PREVENTION OF PARALYSIS. 

By Irving J. Spe.u:. M. 1).. 

Clinical Professor of Nervous mid Mental Dis- 
eases nt the University u\ Maryland. 

In the following pages ] will call attention to 
the more frequent causes of paralysis, limiting 
this term to loss of function of one or more vol- 
untary muscles. I do not wish to convey the im- 
pression that these factors ate capable of bring- 
ing about only motor paralysis, hut for the pur- 
poses of this paper J have limited myself, in their 
relationship, to this form of paralysis. I have 
divided the various causes into six groups and 
then discussed each group separately. We lind 
the same factors at times in more than one group, 
these bringing about deleterious results in more 
than one way; after a summary of the principal 
causes I have taken up the discussion of the pre- 
vention of paralysis, believing as we all must, that 
in order to prevent paralysis we must first be fa- 
miliar with the causes, and by preventing and 
removing these, we may escape the probable se- 
quelke. 

By far the most frequent causes of paralysis 
are diseases of the vascular system. 

Second in frequency are the toxic agents. 

Third, trauma. 

Fourth, infectious diseases. 

Fifth, embryonal. 

Sixth, functional. 

In discussing diseases of the vascular system 
that may produce paralysis, we must consider the 
manifold causes of arterial degeneration and in- 
flammation. Heredity here plays a role, in so far 
as individuals may inherit a poor vascular system 
from parents who are tubercular, syphilitic, alco- 
holic, neurotic, have nephritis or are the subjects 
of any other long-continued chronic disease. In 
early life the most frequent cause of vascular dis- 
ease is infectious in nature, it is as a rule only 



after the individual has passed the adolescent 
period, that he is exposed to the various causes 
of an acquired arterial disease. Of these the 
mine important are syphilis, chronic intoxica- 
tions, infectious diseases, over work, worry and 
chronic constitutional diseases. 

The vascular system must he affected in one of 
four ways to he the causative agent of paralysis, 
or it may lie affected in any combination of these. 
There must he either occlusion of the vessel 
lumen, rupture, deficiency in the vis a tergo of 
the emulation, or deformity of a part of the 
rascular apparatus bringing about abnormal pres- 
sure against nerve elements. 

Vascular occlusion may be transient, — due to 
vascular spasm or pressure, permanent due to 
obliteration of the lumen. The first may be the 
result of emotion, toxic agents, local irritation or 
foreign body; the hitter is the result of inflam- 
matory or degenerative changes in the vascular 
wall, foreign body or pressure against the vessel. 
Under this head come thrombosis and embolus, 
leading to complete or partial, permanent or tem- 
porary occlusion of the vascular lumen. 

Rupture of a vessel is due to too great a strain 
from within or tearing from without. When 
caused from within, we always have a vascular 
wall weakened by some pre-existing cause of ar- 
terial degeneration. 

Those cases due to lack of force of circulation 
are due to a cardiac condition, loss of blood, 
shock or vascular relaxation: this may he tem- 
porary or permanent in duration. 

The fourth cause of paralysis due to a vascular 
condition is that produced by pressure of a ves- 
sel against nerve elements, for example, aneury- 
sm! . 

These various states of the vascular system 
may exist in any region of the body, and de- 
pending upon the location of this condition, will 
be the distribution and type of the paralysis. 

Toxins to give rise to paralysis must first gen- 
erally enter the circulation; they may be exoge- 
nous or endogenous. The exogenous toxins gen- 



102 



THE HOSPITAL BULLETIN 



erally enter the circulation by the way <>l' the 
gastro-intestinal tract although a few gain entry 
through the skin or respiratory apparatus. Cer- 
tain portions of the nervous system have predi- 
lection for certain toxins. The toxin acts by 
causing inflammation and degeneration of the 
peripheral nerves and also has a deleterious effect 
on the central nervous system. Exogenous tox- 
ins, — alcohol is by far the commonest of these 
and has a selective action on the peripheral nerves 
of both lower and upper extremities, arsenic has 
selective action for the radial portions of the 
musculo-spiral nerves, tobacco for the optic 
nerves, lead for the plexus of Meisner and Auer- 
hach. phosphorous, silver, coal tar products, il- 
luminating gas, carbon bisulphide, etc., all are 
capable of causing paralysis. 

Endogenous toxins-diphtheritic toxin affecting 
most frequently the pneumogastrie nerve, al- 
though it may affect any or all the peripheral 
nerves; la grippe, diabetes, chronic nephritis, gas- 
tro-intestinal, rheumatism, tuberculosis, syphilis, 
malaria, typhoid, typhus, scarlet fever, measles, 
whooping cough, erysipelas, smallpox, septicemaia, 
gonorrhoea, etc., are all capable of causing paraly- 
sis by means of the actions of their toxins on the 
nervous S)'stem. 

These toxins may act directly, affecting either 
tin.' peripheral or central nervous system, or may 
act directly upon the vascular system, bringing 
about degenerative or inflammatory changes in 
the vessels or heart, this possibly later on may 
bring about changes in the nervous system which 
may lead to paralysis; thus showing that toxins 
may act either directly or indirectly. 

Trauma, as a cause of paralysis, occurs at all 
ages and may' affect any portion of the nervous 
system. From birth when the application of for- 
ceps to the foetus is followed by the destruction 
of brain tissues and rupture of blood vessels, or 
pressure on cervical nerves causing Ebbs obstet- 
rical paralysis, to the last days of our existence 
we are constantly exposed to harmful effects from 
external violence, which may injure either tem- 
porarily or permanently brain, cord or nerve and 
thereby be followed by temporary or permanent 
paralysis. 

Infectious diseases as causative agents of paraly- 
sis may act in several ways, the infecting 
agent itself may directly invade the nervous sys- 



tem, their toxins may do harm at a distance, or 
either the toxin or infecting agent may involve 
the vascular system and thus bring about harm- 
ful results. The following is a partial list of in- 
fecting agents that may bring about paralysis and 
their manner of doing so : 

By means of their toxins — diphtheria, la grippe, 
typhoid, typhus, scarlet fever, measles, pertussis, 
malaria, variola, erysipelas, septisemia, pneumonia, 
tuberculosis, syphilis, etc. By direct injurious ef- 
fects on the nervous system — anterior poliomy- 
elitis, cerebro-spinal meningitis, syphilis, tubercu- 
losis, typhoid, la grippe, erysipelas, leprosy, beri 
beri, scarlet fever, smallpox, gonorrhoea, Landry's 
paralysis, etc. Through the vascular system — 
syphilis, tuberculosis, typhoid, rheumatism, etc. 

Embryonal causes are the result of some ab- 
normality in the development of the foetus which 
gives rise to an imperfect nervous system, this 
imperfection manifesting itself by symptoms at 
birth or under the stress of existence, appearing 
later in life. 

True porencephaius or absence of a portion of 
the interior of the brain, the defect being occu- 
pied by a prolongation of the cerebral ventricle 
and false porencephaius or absence of a portion 
or the entire hemisphere, the space being filled 
with cerebro-spinal fluid, give rise to paralysis 
affecting one or both sides of the body. 

Bpinabifida or incomplete development of the 
coverings of the cord or of the cord and its 
coverings may be accompanied by paralysis of 
greater or less extent. The spinal cord itself is 
sometimes the seat of deficient or defective de- 
velopment giving rise at any period after birth 
to certain diseases; Freidrieh's ataxia due to early 
degeneration of certain tracts of the cord; syring- 
omyelia due to the development of cavities that 
weie incompletely obliterated during foetal life. 

Functional causes are those to whose action we 
aie, as yet, unable to refer a demonstrable lesion. 
They bring about their results by interfering or 
inhibiting the normal co-ordinate activities of the 
higher psychic centers. Fear, suggestion and 
autosuggestion are the most important and most 
frequent acting functional causes which are fol- 
lowed by paralysis. 

The old adage that an ounce of prevention is 
worth more than a pound of cure may very well 
be applied to the prevention of paralysis, as this 



TIIK HOSPITAL BULLETIN 



103 



is very frequently difficult or impossible of cure 
after it has occurred, whereas by taking proper 
precaution il may often be altogether avoided. 

The embryonal causes, deficient and defective 
brain and spinal cord formation may generally be 
avoided, if only those beget children who are 
physically and mentally healthy, who are Tree 
from hereditary taint, who are living a rational 
life, if proper care of the pregnant mother is 
taken, if she is guarded Erom harmful influences, 
well nourished, have proper diversions, g 1 hy- 
gienic surroundings, and proper medical super- 
vision during the pregnant period. 

The injuries that may occur during delivery 
may be minimized by competent medical atten- 
tion and if they occur should be promptly and 
properly treated. If the child lias escaped the 
dangers of foetal life and of the journey into 
this world, it will now be exposed to the harmful 
effects of trauma, toxins and infection. Trauma 
should be guarded against by careful supervision, 
toxins and infections by proper regulation of the 
diet, this at least if it does not guard the child 
against toxins and infection, places it in better 
condition to resist their effects. If evidence of 
intoxication or infection occur the condition 
should be properly treated under competent 
medical supervision, for even the mildest of 
these conditions may be followed by serious con- 
sequences. 

With few exceptions, until early adolesence, 
the child is exposed only to those deleterious fac- 
tors, that the parents alone can guard against 
and foreset — heredity, trauma and infection. As 
youth ends, and early adult life begins, tempta- 
tions assail the young aspirant, he is exposed to 
the dangers of toxic subjects and venereal infec- 
tion, woe to him if he succumbs, for he has opened 

the portal to the enemy, who once having gai I 

admission is difficult to dislodge. 1 f he has yielded 
to the hue of the drug or acquired venereal dis- 
ease, he must be promptly and properly treated, 
thereby avoiding later prolific sources of paralysis. 
Excesses of eating, drinking, emotion, physical 
and mental work, etc.. should he shunned or a be- 
ginning vascular disease may be inaugurated with 
its later serious consequences. 

There should he proper medical supervision in 
all cases of illness. As old age comes on, as it 
must to all. who has escaped life's earlier battles,) 



ii we would avoid its evident dangers we must live 
a lite ordered to avoid their causes; sudden move- 
ments, constipation, over eating and drinking, un- 
wise exposure to the elements, worry, violent 
physical exertion, neglect of physical and mental 
ailments, etc. 

In conclusion I would advise the observance of 
the following general rules for the prevention of 
paralysis : 

The begetting of children only by healthy par- 
ents, proper care of the pregnant mother, and com- 
petent medical attention during confinement. 

The proper feeding of the infant, good hygienic 
surroundings and prompt medical attention to all 
ailments. 

Guarding as far as possible against trauma, in- 
fectious diseases, etc., and the prompt treatment of 
all diseases. 

Early supervision id' the eyes, ears, nose, throat, 
teeth, et,-. 

A g I moral, intellectual and physical educa- 
tion. Moderation in all habits; eating, drinking, 
working and playing. 

Avoidance of unwise exposure to the elements. 
The cultivation of a peaceful and contented dis- 
position. 



TIIK TREATMENT OF CYSTITIS IN 
WOMEN. 



Pv I. S. Stone, M. !)., Class 1872. 
Washington, D. C. 

A very common disease may he easily over- 
looked and a patient have an incurable disease 
of her bladder because her symptoms were al- 
lowed (o continue while medical treatment is in- 
stituted without direct examination. In my ward 
visit in one of the hospitals with -which I am 
connected, two patients were recently turned over 
lo my service from the medical service. They 
well illustrate my object in writing this paper, 
and I shall allude to them to show what is meant 
by my opening remarks. 

Mrs. A., aged 44, had been having slight fever 

for several weeks. She had pain in the region 

.of both kidneys and back and had lost several 

[pounds in weight. She had frequent mictura- 



104 



THE HOSPITAL BULLETIN 



linn and a deposit of white sediment in her 
urine. Examination of her urine was negative, 
save for epithelial cells and leucocytes. .She had 
taken urotropin, diuretics, tonics and laxatives, 
etc., for several weeks. A pelvic examination had 
not been made. 'Our examination disclosed thick- 
ened bladder walls with greatly diminished ca- 
pacity — not over four ounces. This poor woman 
probably has tuberculosis of one or both kidneys, 
with secondary ulceration of the bladder. 

The other case was in a colored woman, 60 
years of age, who had also been in the medical 
sen ice of the hospital for several weeks. She 
had been unable to retain her urine, and was 
suffering from excoriation and other annoyances 
incidental to a constant leakage. She had also 
taken "urotropin" (the sovereign remedy for 
bladder disease) and was no better after her resi- 
dence in the hospital than before. This patient 
had a bladder capacity of less than two ounces, 
and her bladder felt like a flabby uterus between 
the examining fingers. Its mucosa was thick and 
soft with deep red color and somewhat ulcerated 
and incrusted with the usual deposit of ammonia 
phosphates only seen in belated and neglected 
cases. ' 

This ease appears not to have tuberculosis, but 
merely a neglected bladder I'nim local causes. It 
would be nothing more than right to quote from 
the prescriptions given this patient to show what 
our therapeuticians recommend for a supposed 
"weak bladder," or weak "sphincter meatus 
urinse." Such prescriptions when printed along- 
side the findings in a case such as is now being 
described would indeed be illuminating. But I 
forbear and will now speak of the methods which 
have given the best results to be obtained in 
such cases. 

Examination. We can never be excused for 
omitting an examination when a disease may be- 
come chronic and possibly incurable for the want 
of it. Nearly all the cases of acute cystitis are 
easily curable by direct treatment by bladder irri- 
gation, distension and sterilization. Therefore, 
we repeat this injunction to urge the necessity 
for early and proper treatment. It would be 
well for every female patient in the medical 
wards who is passing urine frequently to have an 
examination by a gynecologist. The medical men 
(the internist) will not practice the touch, and 



hence cannot and in fact frequently do not know 
all that is to be learned by a pelvic examina- 
tion. For instance in the ward cases above men- 
tioned the routine urinary examination will show 
the presence of leucocytes" and "epithelium." 
There may be no estimate of how many leucocytes, 
or of what is now often neglected in such ex- 
aminations, the quantity of mucous found in the 
specimen, nor will anyone know the capacity of 
the bladder. If this urinary examination is sup- 
plemented by a cystoscopic investigation, there is 
frequently enough found to explain all of the ur- 
gent symptoms. But we must excuse the intern- 
ist for not appreciating all of the possible find- 
ings in one of the neglected cases. There may 
be very interesting complications present. One 
never knows what may be found to explain a 
given case. We have found annexal disease most 
frequently to explain the presence of cystitis in 
women although many other causes are frequently 
seen. Calculi in the bladder or ureters may be 
present as jjersistent irritants, and their presence 
should always be in mind. The enlarged and 
thickened ureter found in either renal or blad- 
der cases, may be palpated in those cases which 
are not associated with great thickening of the 
bladder walls, and a stone in the lower end of 
the meter may be located, and afford an ex- 
planation of persistent cystitis. Obviously we 
cannot palpate the ureters when there is asso- 
ciated salpingitis or any induration or other ab- 
normal conditions present. To palpate the nor- 
mal ureter is generally impossible, except in very 
expert hands, but it is comparatively easy to find 
a stone in the ureter if it is near the bladder, 
provided there is no great disease of the various 
organs in the pelvis. 

Treatment. A cardinal principle is to always 
learn the extent of the lesion in any case, but in 
these cases our most important duty is to meas- 
ure the capacity of the bladder. Frequent mic- 
turition means one of two things as a rule, either 
a very sensitive nervous bladder or one contracted 
from cystitis. In view of the urinary examina- 
tion one should easily lie distinguished from the 
other. One thing is evident and most import- 
ant, namely, that the contracted bladder cannot 
be cured of cystitis until it is dilated and ster- 
ilized. We often tell our internes that it is quite 



THE HOSPITAL BULLETIN 



105 



as impossible to treat a lesion of a closed hand 
without opening it, as to attempt to cure a bad 
cystitis without distending the bladder. There- 
fore we must first of all fill the bladder perhaps 
three or four times with normal salt-solution, or, 
better still, boric acid solution, using all that the 
patient will bear. The capacity can be measured 
each time the bladder is emptied, and it will be 
found that the bladder wall often contain a few 
ounces more at the end of the treatment than 
at the beginning. We use ,3 oz. protargol solu- 
tion at piesent, because it is less irritating than 
silver nitrate, and allow the patient to retain 
this in her bladder until the next urination. It 
is our routine practice to use protargol after the 
catheter period in any pelvic operation, before 
the patient leaves the hospital, as we may ex- 
pect to find a small amount of pus in the urine 
di all such patients, and indeed we know of sev- 
eial persistently annoying cases resulting from a. 
neglect of the above precaution. 

To summarize : We would urge a careful pel- 
vic examination in all cases wdiere there is fre- 
quency of micturition with pus or epithelium in 
the mine, whatever may be the condition of the 
patient. We would demand that the capacity of 
each bladder be measured as a preliminary to 
regular treatment and we consider this of greater 
importance than a cystocopic examination, save 
in the most expert hands. After the patient has 
improved, and her condition permits a proper 
cystocopic examination, the results will not only 
be less painful, but the findings more satisfac- 
tory. 



STRICTURE OF THE ESOPHAGUS. 



By Bichard H. Johnston, M. D., 



Lecturer on Laryngology in the University of 
Maryland; Surgeon, to the Presbyterian Hos- 
pital; Consulting Laryngologist to St. Joseph's 
Hospitad; Consulting Laryngologist to the Gen- 
eral and Marine Hospital, of Crisfield, Mel. 

June 15, 1909, Mrs. J. H. M. was referred to 
me by Dr. B. P. Bay. Her history briefly was as 



follows: More than 2 years ago she experienced 
great pain on swallowing, which was located about 
% inches above the cardia. At times the suffering 
seas so intense, she would almost collapse. Not 
long after the attacks of pain had disappeared, she 
noticed that the swallowing of solid food was be- 
coming more and more difficult, until finally she 
was aide to take only liquid diet. When I saw her 
she had eaten no solid food for 2 years; she lived 
on milk and was well nourished. In the sitting 
position and with the head extended 20 per cent., 
cocaine solution was applied to the throat and 
esophagus. Examination of the upper end of the 
esophagus revealed nothing pathological. The 
10 mm. esophagoBcope was then passed and the 
walls of the esophagus carefully examined. About 
2 inches above the cardia a complete stenosis of 
the esophagus was found. No opening could be 
seen, so a fine probe was passed through the 
esophagoscope and careful palpation of the cica- 
tricial tissue made. The probe finally located the 
opeiring; the smallest Bunt bougie was then passed 
through the esophagoscope and the stricture 
dilated under the guidance of the eye. Two more 
Bunt bougies, larger in size, were passed in the 
same manner until the dilatation had reached 
7 mm. Two days later a wax and fibre bougie was 
gently passed through the stricture. Aside from 
slight soreness in the cardiac region the patient 
presented no symptoms. On the fourth day she 
swallowed solid food with practically no trouble. 
The soft bougie was passed daily for a few days. 
One week after the first dilation the esophago- 
scope was again passed, and instead of an imperme- 
able stricture, we found an opening nearly half an 
inch large with walls almost healed. The patient 
was taught to pass the soft bougie and was sent 
home June 26th, able to swallow everything. She 
will continue the treatment at home gradually 
lengthening the intervals between the bougieings 
until one passage monthly will be sufficient to keep 
the opening patent. She had been treated for 
months by the old method unsuccessfully and had 
given up hope of any improvement. It is probable 
that she would eventually have closed entirely and 



106 



TDK HOSPITAL BULLETIN 



a gastrostomy would have been necessary. The 
cause of the stricture was probably an ulcer of the 
esophagus which, in healing, gave rise to the cica- 
tricial contraction. The result in this case was 
brilliant as compared with a gastrostomy, limit's 
bougies are most, valuable for dilating strictures. 
They are made with two olive tips about 1.5 inches 
apart. The smallest bougie has an end tip no 
larger than a line probe, so that after the opening 
is located it is used as a probe and as a guide Cor 
the larger olive. Once through the stricture with 
the small tip, force can hi' applied to the second 
olive with no danger of making a false passage. 
Since everything is dune through the esophago- 
scope, the operator sees every step id' the treat- 
ment. It is obvious that the danger id' making a 
false passage is practically done away with'. After 
the stricture is dilated to ? of 8 mm., it is safe to 
pass the wax ami fibre bougies in increasing sizes. 
The most difficult part of the treatment is the first 
dilatation ami this is made easy through esophago- 
scopy. 



A (ASK (iK PYLolMC CARCINOMA. 



By Robert IL (Jaxtt. '09. 



Senior Medical Student. 

Patient a white male. Spaniard by birth, is oi 
a small statute, but fairly well developed. 60 
years of age. Jlis past history is negative, as 
he docs not remember having bad those diseases 
incident to childhood and as well as he remem- 
bers has always been a healthy individual. There 
is nothing in his family history pointing towards 
his present trouble. 

Piescnt illness: About June, 1908, be began 
vomiting almost every time he would eat. The 
vomitus was irregular in quantity, at times fol- 
lowed by considerable retching, hut never at any 
time containing any blood. 

IIi~ liist signs id' pain would come on follow- 
ing attacks of vomiting and at first were felt in 
the upper abdominal region just to the left .id' 
the xiphoid cartilage. Prom this point it spread 
laterally and over lower abdominal regions. The 
pains aie of a sharp and intense character. He 



is constipated, and it is necessary to purge him 
daily. Pain is of a much less intensity follow- 
ing the use of cathartic. Bowels were regular 
before the onset of this present illness. 

Examination reveals an irregular nodular, 
movable lump in the region of pylorus. Patient 
states that this lump seems to disappear after 
attacks id' nausea. Hepatic dullness is increased 
inferiority. Appetite is poor. 

Las lost considerable weiglit, his present weight 
being 103 lbs. Skin is of dry. yellowish look, pre- 
senting evident signs of cachexia and emaciation. 
Facies are those of one worried and anxious. Ex- 
amination of heart, lungs and kidneys negative, 
arteries are somewhat sclerotic, but the pulse is 
regular in tone and rytlnn and its volume is good. 

Kiine: Clear, sp. gr. 1026 React, acid. Al- 
bumen, sugar. Blood, negative. Sed., scant, 
containing a few renal epithelial cells and ainor- 
phus urates. 

Blood: Leucocytes 8,600. 

Erythrocytes 4,800,000. Haemoglobin 70%. 

Stomach contents. Total acidity 56 degrees. 

Free 11. CL. 0.0876%. Microscopic examination 

shows an excess of starch granules, hut no Op- 

. plen Bras bacilli and no sarcinae. 

Temperature upon admission. 97.4 K.. pulse GO 
to minute, respiration 18. 

Diagnosis: Pyloric carcinoma. Patient en- 
tered hospital on October 12, PHIS, and was or- 
dered for operation the morning id' 14th. Noth- 
ing by mouth was given for twelve hours pre- 
ceding and the stomach was lavaged on the morn- 
ing of the operation. 

Operation: Operator, Or. F. Martin; Assist- 
ant, Or. Lynn: Anaesthist, Dr. Richards; an- 
aesthetic, ether. 

Patient was carried to operating room, and 
pupated for an aseptic operation, abdomen being 
scrubbed with green soap, sterile water, alcohol, 
ether and bichloride. An incision was made 
opening the upper abdomen, in median line — in- 
cision about eight inches in length. The stomach 
was markedly dilated and at the pyloric orifice 
a large malignant growth, carcamatous in char- 
acter was found. The vessels supplying the py- 
lorus, viz: the gastric, pyloric, gastro-epiploca 
dextra and pancreatic duodenalis superior were 



THE HOSPITAL BULLETIN 107 

ligated with linen thread and cut. The pyloric discontinued on the second day following opera- 
ends of the stomach and duodenum were then ticn, as was also the rectal infusion of normal 
freed from their niesentefic attachments and the sail solution. 

ends of the pylorus and duodenum at a sufficient About one week subsequent to the operation, he 
distance above the growth were tied with heavy complained of pain and tenderness upon pres- 
tape to prevent the escape of contents into the sure at tlie upper extremity of the wound. Para- 
peritoneal cavity. Purse-string sutures were in- llnn revealed a sense of bogginess and it was 
serted at these locations where sections were to thought there was a collection of pus in this lo- 
be made and the cancerous growth removed. The cation due to leakage from the stomach. There 
free ends id' the duodenum ami stomach were W as a slight rise in temperature. Three days 
cauterized with pure carbolic acid and washed nil' | atlT t ; 1( . collection worked itself to the surface 
with alcohol and invaginated, the purse-string an ,i the abscess evacuated itself. A small rubber 
sutures heing tightly lied, ami reinforced by a tube was inseited for drainage. The temperature 
continuous Lembert suture. The tape ligatures iin «l pulse immediately fell to uormal and re- 
were then removed from the bowel and stomach, tnained so. 

Xevta posterior gastrojejunostomy was done, a Qn October 2 6, or twelve days following the 

hole being torn through the transverse meso colon „ |1( , ||||illlK he was allowed a Bpecial sof , diet, ,.„„_ 

and the jijenum being sutured to posterior ^ stin g of Boft toast, milk and broths; two days 

stomach wall about iy 2 inches above the greater |;|(r| ||r was g i ven potatoes and allowed poit wine, 

curvature and 3 inches from the pyloric slump. hvj( . (i (| . |i|y . mi| pCT , n i t tet1 to sil up. His Condi- 

The jijenum and stomach wall wen. held tightly tjmi continue(1 to improve and three weeks Eol- 

witll Monihens clamps, the anastomotic incisions [owJng (||( , operation hl . was a ll owe d to walk and 

made, and sutured first with the Council, and paitake ,, r ., „ VIU ., 11US di e t. lie now weighed 

then reinforced with continuous Lembert sutures lf)5 , bg _ t1r , absce8a ,,.,,., al upper e nd of 

of line black silk. The fore end of the dm- wmm] wag rap1d i y m 1 i 1 1 -- in and he seemed in 

deiiuin was then sutuicd to the mesentery. All :i ,., in ,| j t i,, n 

lucks and gauze packing were then removed, the .... , , ,, r 

1 • On November 1. 1908, the patient was dis- 

periloneimi ami fascias closed with line black , , ... 1111 1 1 s a 1,,., 

1 charged. Wound had been closed tor live days 

silk ami the wound closed with a subcutaneous sil- . . . . . . 

and his general condition had \en mucli tm- 

vcr wire suture. Silver foil and stock dressings , tl . ,. , , , ,, , , -, ,, . 

proved. Duung Ins last week in the hospital he 

were applied ami Ihe patient returned to his .. . , ... ,... 

11 ' luiil named (>' -_ lbs. in weight, and his condition 

loom in fair condition, he being slightly shocked. 

is quite a contrast to that ol live weeks ago upon 

Duiing the operation strychnine was administered .. 1; -, • . 

' J entrance. Instead ol discontent, distress ami evi- 

to the extent of 1/15 of a "-rain and immediately , . . , , , „,,. 

dent imhapprness and anxiety, he now is cheerlul. 

following a rectal infusion of normal salt was ,,,,,,.,1 ,.,,,,,1; 

8 contented and comfortable, ins general conai- 

administereil, and ordered g. four hours, , , . , K ,■ 

lion is decidedly better ami he is paitainng ol a 

strychnine 1/30 g. four hours. . .. ... .. ,. 

' ■ lihcial diet, with no cliscomiort. 

Following the operation the patient had some 
slight reaction, hut this soon Subsided, tempera 



Flu- patient was heard from about Fein nary 



ture and pulse remaining normal. Nothing was 1- and was doing well, lie had returned to his 

given by mouth until second .lay following, when work, that of a cigar maker, and was suffering 

small quantities of albumen water were allowed. no discomfort or distress. In his own wo, ds. 

The patient was resting well and stimulation was he was very happy and enjoying hie. 



108 



THE HOSPITAL BULLETIN 



DIAGNOSIS IN CHILDHOOD. 



By Nathan Winslow, M. D., 

During the first few years, the physician has to 
rely upon the objective signs of disease, for the 
child is unable to describe its subjective symptoms, 
but the two following fundamental principles are 
of great assistance in arriving at a proper diagno- 
sis; on the one hand it is a well known fact that 
pathological processes at this period of life are 
practically limited to the gastro-intestinal tract. 
the lungs, and the brain: and on the other hand 
owing to the extreme susceptibility of .the nervous 
mechanism of infants, functional derangements 
are often accompanied by very grave symptoms, 
and may even prove fatal in twenty-four hours, 
or there may be speedy and complete recovery after 
very alarming symptoms. 

In seeking a diagnosis, it is best to start with 
the history which may be obtained from the 
mother, after which a methodical physical exami- 
nation is in order. 

History. — The previous, as well as present his- 
tory of the child should be minutely investigated. 
The nature of the delivery, whether normal, in- 
strumental, tardy, or precipitate, is an extremely 
valuable aid to diagnosis. In disturbances of nutri- 
tion not only enquire about the nature and 
amount of the food given, but also how prepared. 
Do not fail to ascertain whether the child has been 
gaining or losing weight. Investigate the time of 
the eruption of the teeth. Ask at what time the 
child began to stand and walk alone. Make it a 
point to ascertain the acute infectious diseases the 
baby has had. Find out the time of onset of the 
]■ resent malady, and how it was ushered in. Ask, 
if the temperature has been elevated; if there has 
been any cough; if there has been any evidence of 
pain. Observe whether the child is restless. In- 
vestigate the character of its sleep. The bowels 
should not be overlooked, learn whether they are 
constipated or loose, and the number and amount 
of the stools passed in a day. The amount of 
urine and the frequency of micturition should be 
fully ascertained. Question the parents, in case 



of suspected congenital syphilis, about their pre- 
\ Lous life. 

Physical Examination. — In order to make a 
thorough examination, our ingenuity, time, skill, 
perseverence, and tact are taxed to the utmost, 
before the desired information is obtained. In go- 
ing over a case, exactly the same method of pro- 
cedure is followed as in the adult. Begin with an 
inspection of the different regions of the body, 
palpation, percussion, auscultation, and the vari- 
ous instruments of precision have their fields of 
usefulness, but in any case patience, tact and time 
are essential to a proper and thorough examina- 
tion. 

[nspection. — Bare the part to be examined, 
even without touching the child, especially if 
asleep; very important information can be gained. 
If the child is asleep, note whether it lies on its 
face or back. In cerebral involvement it may be 
in a position of opisthotonus. Note whether the 
sleep is (pliet or disturbed, whether the respirations 
are normal or abnormal, whether there is an erup- 
tion on the body, whether there is athetosis. 
Palpable deformity is obvious. 

Skin. — The color of the skin should not be 
neglected for it often gives us important clues to 
the pathological process going on. In anemia one 
is struck by the extreme degree of palor. In 
chronic indigestion the skin takes on a peculiar 
hue, and is often wrinkled from absorption of the 
subcutaneous fat. A bluish tinge of the lips or a 
cyanosis of the extremities should direct our at- 
tention to the heart, or lungs, and is due to a 
sluggish capillary circulation. In obstructive dis- 
eases of the upper air passages, the patient takes 
on a leaden color. In shock the skin is pale, cold, 
and clammy. In the eruptive diseases the skin is 
of the utmost importance in diagnosis. 

Attitude.-— A healthy child, when not asleep, 
should be more or less constantly in motion. When 
you encounter a child over six months of age not 
active, it in all probablity, is suffering from mal- 
nutrition. When a child eighteen months of age 
does not walk, you should think of rickets as 
being the probable cause. If upon inspection a 



THE HOSPITAL BULLETIN 



109 



jrint is found in semi-flexion, yon may be cer- 
tain an inflammation is present. If the child is 
suffering from a unilateral pneumonia, it will lie 
upon the affected side, which upon inspection will 
lie found to be motionless. In diseases of the cir- 
culatory system, the posture is of great import- 
ance as a guide to diagnosis. In cardiac dilatation 
a semi-flexed sitting posture is assumed. In deep 
seated abdominal inflammations the patients lie 
unon their back, the muscles are rigid, and the 
thighs are flexed on the pelvis, and the legs upon 
the thighs. In meningitis, when the intellect is 
affected, the child will lie in bed in one position. 
"Whenever yon see an arm drop helplessly as in the 
dissecting room, there is an extreme decree of in- 
toxication. In Pott's di=easc the posture is very 
characteristic. In children many of the acute in- 
fections diseases are ushered in by convulsions. 
Tf these occur at the onset of the malady, thev 
are not as serious as those which take place at the 
termination of the illness. 

Movements. — There is a group of diseases 
(nervous) whose presence is indicated by certain 
movements. In tubercular meningitis the head 
i« continually turned, from side to side, and the 
hand at the same time is carried to the head. Tn 
ca°e of hunger the babe grasps at everything within 
reach, and is constantly putting its hand to its 
mouth. It should be borne in mind that in many 
chest diseases, the patient will nib its abdomen. 

Cry. — The cry of the child is of considerable 
importance as an aid to the diagnosis of quite a 
number of diseases. One should be able to recog- 
nize whether it is due to anger, pain, habit, hun- 
ger, etc. Do not say the child hasn't pain, if there 
are tears, for they are not present before the second 
month. The cry of hunger is not sharp or pierc- 
ing, but is long continued, and the hands are con- 
tinually carried to the mouth. The cry of pain 
within the first two weeks of life. In this case 
the cry is loud, and prolonged ; the body of the 
child is stiffened ; the head is thrown back ; and 
the child kicks violently. Extreme degrees of ex- 
haustion are characterized by a low. feeble whine 
or moan. The cry of habit is very difficult to 
recognize, but can be told by the child ceasing to 
cry, when its wants are satisfied. 



Certain diseases have characteristic cries, as the 
short, catchy, suppressed cry of pneumonia; the 
sharp nocturnal, hydrocephalic cry of tubercular 
meningitis; the hoarse, nasal cry of congenital 
syphilis; and the suppressed muffled cry accom- 
panying atelectasis. 

■ Vomiting is very much more frequently ob- 
served in childhood than later in life, and has not 
the same significance. Owing to the more vertical 
position and size of the stomach food in overdis- 
tention is very frequently regurgitated. Gastro- 
intestinal affections are sometimes cured by vomit- 
ing. The act of vomiting often serves as an indi- 
cation of beginning infectious diseases, such as, 
scarlatina, measles, lobar pneumonia, which later 
in life are ushered in by a chill. Vomiting is 
sometimes an indication of nephritis. In cases of 
peritonitis and appendicitis, vomiting occurs as a 
very early symptom. 

Mouth. — The mouth and tongue are often 
characteristic of certain diseases, e. g., measles, etc. 
Lesions of congenital syphilis make their appear- 
ance on the mucous membrane of the cheeks. The 
tongue likewise gives us important information 
about changes occurring in the body. In many of 
the diseases of the stomach and intestines the 
tongue is drv and shows a tendency to crack. In 
exhaustive diseases, it is coated with a whitish, 
yellowish, or brownish debris. In scarlet fever we 
have the strawberry tongue. In nervous exhaus- 
tion it often is very much swollen. One of the 
cardinal signs of scurvy is the swollen and hemor- 
rhagic condition of the gums. 

Throat. — Never omit an examination of the 
throat. Look on the hard palate for the eruptions 
of the acute infectious diseases. 

Stools. — Never neglect to inspect the stools 
yourself in bowel complaint, as some important in- 
formation may be derived by this procedure. Pure 
blood is seldom passed by these tiny patients, it is 
due to hemorrhoids, to which children are exempt, 
or to some obstruction of the lower bowl. In 
enterocolitis you have blood mixed with mucus in 
the fecal mass. 

Urine. — The urine should be subjected to the 
same tests as adults, and the physician should make 
it a routine practice in every physical examination 



110 



THE HOSPITAL BULLETIN 



to examine this secretion. In the male it may be 
collected in a con&um, in the female in a cup 
fastened over the vulva. 

Pulse. — Changes in the rhy thm of the pulse are 
not so significant as later in life. See if it is 
rapid or slow; full or strong; soft or compres- 
sible. A slow, irregular pulse often suggests 
meningitis. 

Heart. — Acquired organic heart disease does 
not as a rule appear until the third year. If loud 
murmurs are heard, they are almost certainly of 

congenital origin, soft ones are functional. 

Respirations. — Changes in rhythm of lespha- 
tions are not so significant as later in life. Note, 
whether it is regular or irregular; whether slow, 
rapid, easy, quiet, snoring, or noimal. Mouth 
breathing may be caused by ti nisi litis, adenoids. 
diphtheria or any congestive affection of the nasal 
passages. 

Temperature. — In making an examination of a 
child, always ascertain whether fever is present. 
To get this properly, do not rely upon the mouth 
or axillary method, but take it pel' rectum. The 
average temperature of the child is 99° F. Nerv- 
ous, high strung children are prone to take on fever 
on the slightest provocation. This rise is due to 
a functional disturbance, and subsides after a lew 
hours. Underfeeding is followed by a rise in tem- 
perature". The temperature of premature chil- 
dren is often subnormal, but can he raised by arti- 
ficial means. I'ulse rate and lone aie of more im- 
portance than the range of the thermometer. 

Facial Expression. — Note whether the fea- 
tures are calm, or drawn and anxious, intelligent or 
stupid.. Pain frequently manifests itself by con- 
traction of the facial muscles. 

Cough. — Carefully ascertain whether the cough 
is constant, barky, croupy, light, loose, or Severe; 
and the nature id' the sputum, expectorated should 
not lie overlooked. 

Eyes. — If the mother has a vaginal discharge, 
the eyes should receive careful attention, else they 
may give great trouble and anxiety. Ascertain in 
an examination id' these organs, whether the pupils 
lead to light, and whether they are dilated or con- 
tracted. Interstitial keratitis indicates the pres- 
ence of congenital syphilis. 



NOSE, — Any nasal discharge should be carefully 
noted. If acute, suspect diphtheria, scarlet fever, 
influenza; if chronic, the most likely causes are 
adenoids and syphilis. 

Abdomen. — Look for tympanitis and points of 
tenderness. Note whether the abdomen is re- 
tracted as in meningitis. Try to palpate the dif- 
ferent abdominal viscera, for the liver and the 
spleen are sometimes found to be displaced;, especi- 
ally, in contractions of the chest due to tickets. 
In acute diseases an enlarged spleen suggests 
malaria, typhoid fever, tuberculosis; in chronic 
maladies, malaria, syphilis, and leukemia. 

Bones. — Be sine to note any enlargement of the 

osseous structure and always look for points of ten- 
derness. 

Skull. — Determine by running the fingers over 
the head, whether the fontanelles ami sutures aie 
opened or closed. 

Glands. — Enlarged cervical glands may lie due 
to acute tonsilitis, diptheria, measles, etc., so do 
net fail to examine them when going over a 
patient, as they may guide us to a proper diagnosis. 

General Condition. — Observe whether the 
mu sell's aie llahbv or well nom is bed ; whetlier there 
is any deformity of the bony system. Investigate 
depends upon its severity. It is sharp and pierc- 
ing, tlie features aie contorted, and there are other 
signs of distiess. The cry of temper is present 
sight, speech, and general menial development. If 
the child is able to lell its Symptoms, do not In In 
obtain I he facts desiied too quickly. 

Palpitation. — The hands must be warm. We 
rarely fail to get the fremitus of the civ, and this 
is usually great, <]uc to the thin walls. Mucous in 
lubes will be indicated by a rhonchial fremitus, and 
is signilicant of bronchitis. Locate apex beat of 
the heart, which is usually in fourth intercostal 
space. 

Percussion. — To percuss the back, have the 
nurse resl the child over her shoulder. Owing to 
the thin chest walls, and large bronchi the percus- 
sion note is rather tympanitic, and is exaggerated 
on the i ight side. 

Auscultation. — Ausculate the posterior chest 
wall first as the child is not so apt to be frightened, 
also because evidence of disease oftentimes lirst 
makes its appearance here. 



THE HOSPITAL BULLETIN 



111 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 
EDITED BY 

A COMMITTEE OF THE HOSPITAL STAFF 



PUBLISHED BY THE 

HOSPITAL BULLETIN. COMPANY 
University of Maryland 



Business Address, 
Editorial Address, . 



. . . Paltimore, Md. 
University of Maryland 



Baltimore, Md., August 15, 1909 

THE SOUTH'S PROSPERITY. THE OPPOR- 
TUNITY POP, EDUCATIONAL INSTI- 
TUTIONS OF BALTIMORE. 

The marvelous natural resources <>t' the South 
summed up by Mr. <J. (J. Dawe in an ad- 
dress delivered at the meeting of the Southern 
Commercial Secretaries' Association, Atlanta, Ga., 
recently, almost stagger the imagination of peo- 
ple who have not investigated the great possi- 
bilities for developmenl in the agricultural and 
commercial growth of the Southern States. Mr. 
Dawe shows that the South has the largest ana 
of workable land awaiting agricultural develop- 
ment of any section of this country; that she has 
II per rent, of the standing timber of the United 
States; of navigable riveis to the total mileage 
of 26,410 miles, the South has l8,21o miles. She 
has 3,000 miles of coast line, while the Atlantic 
ami Pacific Coasts combined have only 2,400 miles. 
She has thriving ports, which when the Panama 
Canal is opened, will preseni enormous oppor- 
tunities to trade with the South American coun- 
tries. The Southern people an 1 ta-i awakening to 
a realization of the possibilities of development id' 
these vast resources in manufacturing, mining and 
agriculture. She is forging ahead with marvelous 
speed. 

In matters of education the Southern universi- 
ties, colleges, public ami private schools arc grow- 
ing in like proportion. Baltimore being the lead- 
ing metropolis of the South, should he made a cen- 
ter id' her educational Interests. By reason of ber 
population, her climate, her social advantages, she 
presents facilities for educational training not pos- 
sessed by any other city in the South and not sur- 
passed hy any city in the Ninth. 



Baltimore should he made a great educational 
Center and it would he wise upon the part of our 
educational institutions to reach out after stu- 
dents from the South. They can tind in Balti- 

re opportunities which .cannot he found in other 

cities. These facts apply with special force to the 
medical school- of our city. 

We have in Baltimore six medical schools uow 
in active operation and educating over 1,500 
medical students. It will lie an easy matter for 
these institutions to double the number of stu- 
dents from the South as well as from the North, 
if the advantages of education are properly pre- 
sented to the large body of young men who are 
seeking-an education in medicine. The medical 
schools of Baltimore possess unusual advantages 
for scientific and clinical instruction. With hos- 
pitals and laboratories well equipped for instruct- 
ing students, with teaching bodies well organized 
and trained for giving instruction, it is possible 
to give an education m medicine that will equip 
the medical student for the highest work in his 
profession. 

It remains for the institutions of this city to 
present in a forcible way, the opportunities which 
lhe\ cm offer to the medical student and the 
Bulletin is of the opinion that those institu- 
tions which get in -line and make good in their 
work of instruction will prosper through the op- 
portunities which will he presented to them. 

Baltimore possesses a (Innate, a social life ami 
all the desirable features which should make the 
residence of the student here a profitable one. 
Tlie amount of clinical material to he round in 
our larger hospitals, if fully utilized, could he 
made to give lwo-1'old the amounl of instruction 
which is now del ived from it. 

In reaching out after students, it would he 
well for the medical institutions of Baltimore to 
emphasize the fact that clinical teaching and lab- 
oratory instruction can he found here in the great- 
est abundance. 

The immense development of the Smith's 
material wealth is Baltimore's opportunity. Her 
commercial bodies realizing the source of the 
Smith's vasl wealth, ate using every effort to a(- 
ii.et attention to this city as a manufacturing 
ami distributing center. Why should not medi- 
cal schools of this city realize the position which 
they enjoy and organize with the same purpose 
ill view ? 



112 



TIIK HOSPITAL lil'LLLTIX 



THE ANN PAL CATALOGUE FOB SESSION. 
1909-10. 

The annua] catalogue recently issued by the 
I »can of the Faculty of Physic of the University 
of Maryland presents a general statement of the 
work in the Medical Department during the past 
session and an announcement of the course for the 
coining session. 

Whilst few changes have been made in the work 
proposed, the report for the past session shows 
many evidences of progress. 

During the session there were 329 medical stu- 
dents in attendance, of which number 89 received 
the degree of Doctor of Medicine. Forty raem- 
bers of the present fourth year class were ap- 
pointed clinical assistants to the Fni versify -Hos- 
pital. The Hospieal staff now numbers fourteen 
assistant resident physicians, surgeons, obstetri- 
cians and pathologists. The Training School for 
Nurses numbers 64. During the year 1908-1909 
4,947 patients were treated in the University Hos- 
pital, while in the outdoor department 31,423 
patients were treated. This rich field of clinical 
material was used in the clinical instruction of the 
students in attendance. 

In the Maternity Hospital of the University 
235 indoor confinements were attended and 448 
outdoor, a total of 683 cases, making an average 
of 33 cast's of labor seen by each student of the 
graduating class. In addition to the above the 
students of the graduating class received instruc- 
tion in Bayview Hospital, Hospital for the Belief 
of Crippled and Deformed Children and Presby- 
terian Eye and Ear Hospital. 

The Bulletin doubts whether any medical 
school in this country can offer to its graduating 
class larger or better facilities for clinical work 
and instruction than the University of Maryland. 
In this field she stands ready to show results or 
to institute comparisons. The future of the Uni- 
versity was never more encouraging than it is to- 
day. Her plant and organization arc keeping 
pace with every requirement of a great clinical 
school. The spirit of harmony and progress is 
the spirit of her teaching and student bodies. All 
are striving to do efficient work in imparting and 
in receiving instruction. These statements are not 
made in a boastful spirit, but with an honest desire 
to assure the alumni of the University who have 
few opportunities of visiting their old Alma Mater 
just what she is doing and how far she is making 



good bar claims upon them for respect anil co- 
operation in her work. 



CORRESPONDENCE 



Santiago de los Caballekos, 

Rkpublica Dominicana, 

July 1, 1909. 
Deah Mi;. Editor: 

Piesuming that you might have a small corner 
in your interesting little Bulletin, I am send- 
ing you a report of one of several cases of "Te- 
tanus." that has recently fallen to my lot, and 
that may prove of interest to your readers. 

Tetanus is very prevalent in this country and 
as in all countries has a high mortality, the 
treatment only makes us realize how little we 
can accomplish. My own experience with the 
serum as a curative measure has been anything 
I nit encouraging. Perhaps the serum supplied 
has been at fault. Certainly the conditions in 
the tropics are not favorable to its preservation 
for any length of time. Some months ago I had 
heard or read of the use of sulphur in Tetanus, 
and resolved to try it. Since using this drug 
1 have had five good cases to attend, three of 
which are still alive; in the other two cases the 
patient had been neglected until too late to de- 
rive any benefit from any treatment. I will cite 
one of my successful cases. On Feb. 12, 1909, 
I was called from Santiago to Laguna Salada, a 
distance of 45 miles, to see a young man with 
"spasm." On arrival I found the patient sur- 
rounded by several friends, struggling fearfully. 
Gradually 1 got the history of a cut foot following 
a bath in the river. ■ Ten or twelve days later began 
to have attacks, gradually growing in violence 
until at the time of my arrival the attacks were 
about every twenty minutes and very violent. All 
the muscles of the body involved, and the patient 
during the attacks very violent, it being neces- 
sary for two or three men to control him. His 
anus especially were involved and the set of the 
jaw muscles gave the characteristic "Risus Sar- 
donicus." After each spasm the poor fellow 
would show how completely exhausted he was. 
Although the spasm was over, his muscles still 
retained some rigidity and he perspired profusely. 
He had one degree of temp. In these countries 
when a man's inipedinieiitcT is crowded in his 
saddle hags, the opportunity to confirm one's 
diagnosis microscopically is denied you. But hav- 



THE HOSPITAL BULLETIN 



113 



Lng eeen so much of this condition, I feel sure 
of the diagnosis. I immediately confiscated all 
the "Mauteea," or Dative butter in the hut. and 
roughly made up with 5ii °f sulphur precipi- 
tate and Vt> a lb. more or less of butter an oint- 
ment, and picking out two strong young men 
staited them to work rubbing the ointment into 
the chest, abdomen, loins, groin and axillae; as 
these fellows tired two others continued the rub- 
bing, lesting only at the spasm. Every two bonis 
1 gave one teaspoonful of sulphur precipitate in 
a little milk, by mouth. Leaving my directions 

thus, I slung my ha lock in a neighboring 

booeja, I slept for four hours. On awaking I 
was informed that the attacks had been less fre- 
quent and weaker, lasting a much shorter time. 
This treatment was kept up for fifteen hours, at 
the end of which time he bad passed three bonis 
without attack. His body muscles were almost 
completely relaxed and he was dozing comforta- 
bly. The last attack had been very feeble. I 
reduced my treatment. 5i P rec - sulphur every 
four hours, in milk and left him. His recovery, 
I was later informed, was rapid — in several days 
he was up and out. 

This is one of three cases treated with sulphur. 
The two fatal cases I mentioned had been for 
days without treatment (except the native witch 
doctor), and were not fair cases. 

Chahles Haddwick. M. D., 

Class of 19(14. 



THE OPENING OF THE GENERAL AND 

MARINE HOSPITAL AT C'RIS- 

FIELD, MARYLAND. 

Ckisfikld, Md., June 30th, 1909. 
To The Hospital Bulletin : 

Crisfield is the southernmost town of any con- 
siderable size in the State of Maryland. Its popu- 
lation is approximately 5,000 people, and there is 
perhaps another 5,000 within an area of 5 miles. 
It is a port, of entry of the United States ami it 
is said that the number of vessels registered at this 
port is exceeded hut by two or three other ports 
in the country. Although it lias a large number 
of vessels, they are of small size and light tonnage. 
The chief industries are connected with the water 
and consist of crabbing in the summer and oyster- 
ing in the winter. It is said to be the largest 
crab market in the world. Owing to these in- 
dustries a large number of men are employed who 



come from all parts of the country, and until the 
present time there has been no adequate provision 
for the care of these people when sick and injured, 
and hitherto they have been treated at their homes 
by the local physicians or sent to Baltimore or to 
other cities where hospitals are located. 

Today is a red letter day in the history of Cris- 
lield for it marks the fruition of plans that have 
long been in preparation for the establishment of a 
hospital in this city. The General and Marine 
Hospital was dedicated today and will soon be 
opened for the reception of patients. The Hos- 
pital will he under the professional care of the 
physicians of Crisfield and id' Somerset county, but 
a staff of consulting physicians and surgeons from 
Baltimore wall assist them in their work. 

In company with Drs. J. Fred. Adams, .1. M. 
Craighill and Nathan Winslow, 1 attended the 
opening ceremonies of the Hospital. A large com- 
pany was present from the town and surrounding 
country as well as from nunc remote points ami 
the board of lady managers served an elaborate 
entertainment for those who were present. Or. 
Gordon '1'. Atkinson presided ami introduced the 
speakers. The Governors of Virginia and Mary- 
land were both expected to he present, but neither 
of them put in an appearance, consequently their 
places in the program had to lie filled by others. 
and I believe I was the substitute for the Governor 
of Maryland. In fact, it seemed to lie my lot to 
he mistaken for the Governor, as when Dr. Craig- 
hill ami I walked up the street at Crisfield, we 
met an elderly man leading a brindled bull dog, 
named Mike, who inquired: "Is any one of you 
gentlemen the Governor?" Perhaps, however, he 
thought Dr. Craighill, with his dignified manner 
and impressive bearing to fie the Governor, and I 
only the Secretary of State? 

The Hospital is situated on the main street of 
the city and consists of a two-story building which 
is very well adapted for the purposes to which it is 
devoted. It will have accommodation for aboul 
".-(> patients and has been well furnished with beds 
and other necessary fixtures as well as with the 
necessary equipment of a modern operating room. 
Crisfield is to be congratulated upon having this 
institution for the care of its sick and suffering, 
for not only will it he a boon to those who seek 
entrance into its wards, but it will also be a greal 
educational factor in the training of the physician's 
id' the town and county, as well as a center from 
which important hygienic and sanitary informa- 
tion will be disseminated amongst the people. 



114 



T 



HOSPITAL BULLETIN' 



As in other portions of the Eastern Shore, hos- 
pitality reigns supreme, and during our stay in the 
town every possible courtesy and attention was 
shown us. Crisfield may be reached by steamboat, 
leaving Baltimore about 5 o'clock in the afternoon 
and reaching Crisfield very early in the morning. 
The trip down the bay is very pleasant and i n j \ 
able, luit the early hour at which one is obliged to 
disembark is far from agreeable; or one may take 
the train at Union Station and changing to the 
Delaware Railroad may. by a circuitous route, 
reach Crisfield in five or six hours. It is. however, 
a much more pleasant trip to go by steamboat. At 
the time of our arrival the boatmen were beginning 
ti' go but in their boats to their daily work. These 
boats going out in large numbers present a verj 
beautiful and interesting sight and with their sails 
spread resemble hocks of huge birds skimming over 
the sin face of the water. They come hack laden 
with crabs, or oysters, or other sea game. Another 
very peculiar and interesting industry is that of 
raising terrapins for the market. One terrapin 
pond which we visited was tilled with thousands nf 
diamond hack- and other varieties of terrapin. 
These terrapins are exported to New York and 
other large cities and arc sold at high pi ices to 
the Famous hotels and restaurants of these centres. 
Diamond hack terrapins seven inches in length sell 
for $3 apiece, whilst those eight inches in length 
bring $100 a dozen. They are caught by hunts- 
men, who sell them to the owner of the pond, who 
keeps them until they are lit l"r the market. 
There is an obsolete law which prohibits Feeding 

slaves on dia nd hack terrapin oftener than twice 

.• day. 

The University of Maryland is well represented 
at Crisfield by its medical graduates, Drs. ('. E. 
Collins, W. II. ('.illumine. Win. F. Hall. G. T. 
Simouson and .1. F. Somers, who are all estab- 
lished in extensive practice, and by Dr. R 1!. 
Xoriis. lately of Baltimore, who has verj recently 
removed to Crisfield. 

Randolph Winslow. 



ITEMS. 



Doctor Nathan Winslow, class of 1901, of Bal- 
timore, has left for Richmond, where he will visit 
points of interest. 



residence of a year in the interior of Brazil, where 
he has been engaged in the practice of his pro- 
fession. In three months' time he expects to re- 
turn to Brazil. 



Doctor Edson W. Glidden, Jr., class of 1907, 
nf Savannah. Ga., and formerly a resident physi- 
cian in the University Hospital, has been spend- 
ing a few days in Baltimore visiting the Uni- 
versity Hospital. 



Doctor St. (lair Spruill has been elected assist- 
ant surgeon to St. Agnes' Hospital. Baltimore, and 
Doctor John T. O'Mara has been appointed his 

assistant. 



Doctor John Wilson MacConnell, class of 1907, 
of North Carolina, recently visited the University 
Hospital, Amongst other visitors may lie men- 
tioned Dr. Washington Claude, class of 1ST."), of 
Annapolis. Md., and Iiul'us Cecil Franklin, class 
of l!tt>7. ,,f Georgia. 



Doctor and Mrs. William Hewson Baltzel, of 
Boston, aie spending a frw days at the Hotel 
Belvedei e. Baltimore. 



Doctor William Emrich, class of 1902, of Bal- 
timore, has returned to his native city after a 



Doctor Harry Young Righton, class of 1907, of 
Savannah, Ga„ is visiting friends in Baltimore. 
After the completion of his course at the Uni- 
versity of Maryland he was resident physician at 
St. Joseph's Hospital. Baltimore, for a year. 

Dr. T. A. Ashby, of the Faculty of Physic, has 
been nominated by the Democratic party as one 
of its candidates for the Legislature, from the 
Third District of Baltimore city. The nomina- 
tion came to Dr. Achby unsolicited, and he was 
induced to accept it against his personal interests 
as a duty which he believed he owed the medical 
profession and people of the State. 

Dr. Ashby is the only physician in the city dele- 
gation and will lie in a position to render a most 
eilicient service in trying to procure the passage of 
laws which will improve the health, comfort and 
educational interests of out people. 

If elected he will go to Annapolis with the 
sole purpose of trying to use his influence and 
ability I'm- the general uplift of all classes of Legis- 
lation. His long training as a practitioner of 
medicine, teacher and editor, and his large ac- 
quaintance with physicians throughout the State 



THE HOSPITAL BULLETIN 115 

ami with public officials will be of greai service Dr. Samuel Theobald lias returned to his home 
to him as a member of the Legislature. limn a visit in New London, Conn. 



After baving a haul fight against <lratli Dr. A. The Baltimore County Medical Society met at 

L. Wilkinson, Cole avenue and Belair ro,ad, ltaspe- Springfield Hospital, Sykesvijle, July 15, 1909. 

burg, is now able to attend to his professional After luncheon Dr. .1. Clement Clark, class 

duties again. 

of issi. superintendent of the hospital, showed the 

Doctor ami Mis. Henry B. Thomas have closed visitors over the institution in company with the 

their house at Catonsville ami are spending July city grand jury. The members' of the society ex- 

aml August at Blue Ridge Summit. Pa. pressed themselves pleased with the management 

of the hospital ami its methods. The society was 

Doctor .1. Clement (lark, class of 1861, of addressed by Dr. (lark. Among those present 

Sykesville, Md.. is spending the summer at Ocean «'ere: Drs. John Winslow, M. (i. Porter, F. J. 

City, Mil. Kiihy. Heniy A. Xavlor. II. Louis Xavlor, Josiab 

S. Bowen, A. D. McConachie, J. P. II. Gorsuch, 

Doctor and Mrs. Frank Chisolm, of Washing- Frank J " Keatin g- 



ton, formerly of Baltimore, left recently for the 

Berkshire Hills, where they will spend their sum- Doctor W. F. Wiegand and family have gone to 

mer vacation. Asbury Park, New Jersey, for the summer. 



Doctor H. W. Wickes, passed assistant surgeon, Dr. and Mrs. (J. \\". Dobbin have closed their 

United States Public Health and Marine Hospital town house and taken a house on Charles street, 

Service, has been granted one month's leave of extended, for the summer, 

absence from August 1. 1909.. 

Dr. R. B. Warlielil has left for a six weeks' stay 

Dr. Eugene H. Mullan, passed assistant surgeon in Europe. 

of the same service, has been granted two days' 

leave of absence from July 12, 1909. Dr. C. F. McElfresh and family have left for 

Fairmont, West Virginia, where they expect to stay 

Doctor and Mrs. James M. Craighill have left '" lm ' tni " ■ 

for Canada, where they will spend a month at the . 

various places of interest! Dr. Hiram Woods has returned from New Lon- 
don. Conn. 

Doctor Martin J. Hanna, a graduate of Sewanee 

University, hut formerly a member of the class of Dr. and Mrs. Frank Crouch are in the White 

1908, was married recently to Miss Sarah S. Fust, Mountains, where they expect to remain several 

at the home of the bride, 113 North Fremont ave- weeks. 
nue. Upon their return from a honeymoon, spent 

in the North, Dr. and Mrs. Hanna will reside at Dr. Prank Martin will spend the late summer 

■.'."> 7 Xorth Fulton avenue, Baltimore. in Europe. 



Doctor John S. Fulton has sailed for Europe Dr. and Mrs. J. William Funk are spending the 
where he will spend the remainder of the summer summer at Ocean City, Md. 
traveling. 

Dr. Silas Baldwin has almost recovered from the 
Doctor T. C. Gilchrist has sailed for Europe recent driving accident in Druid Hill Park, 
where he will visit [mints of interest. 



Dr. Allan Walker, class of 1886, of Washington, 

Dr. and Mrs. Irving Miller are summering in D. ('.. recently paid the hospital a visit where he 
•Maine. renewed old acquaintances. 



116 



THE HOSPITAL BULLETIN 



Professor Charles Wellman Mitchell, one of 
the regents and formerly dean of the medical de- 
partment of the University of Maryland, recently 
appointed to the vacancy in the chair of medicine 
caused by the recent resignation of Professor Sam- 
uel ('. Chew, is a native of Baltimore and for some 
years has held the chairs of Diseases of Children. 
Therapeutics and Clinical Medicine in the Medical 



Faculty, the latter two of which lie now relin- 
quishes. He received the degree of Bachelor of 
Arts at Princeton in 1879, and afterwards the de- 
gree of Master of Arts. 



Doctor Arthur M. Shipley, associate professor 
of surgery, has been made professor of therapeutics 
and surgical pathology and a member of the Board 
of Regents. Dr. Shipley, who is from Anne 
Arundel county, was honor man of the class of 
1902. After graduation he was appointed assist- 
ant resident surgeon to the University Hospital, a 
position he held two years, then was promoted to 
the superintendency of the University Hospital 
where he remained until June, 1908, when he en- 
tered upon the practice of surgery in the city of 
Baltimore. 



Doctor A. Duvall Atkinson has resigned his 
clinical professorship of medicine. He and his 
wife will spend the summer touring Europe. 



Under the caption of leading men of Maryland 
the Baltimore Star presenting his portrait has 
this to say concerning Doctor Joshua W. Hering. 
class of 1855 : 

"Dr. Joshua W. Hering, who in December will 
end his third term as State comptroller, and who 
will be renominated for a fourth term at the 
coming Democratic State Convention on August 
11, 1909, is probably the most popular man today 
in the Democratic party in Maryland. Besides 
being a physician and State comptroller, Dr. Her- 
ing is a hanker. His home is at Westminster. Be- 
fore his election as State comptroller, in 1899, he 
had served two years in the State Senate. In 
point of age and public service, Dr. Hering may 
be called the grand old man of the Democratic 
party. He has passed his seventieth milestone." 



Doctor Elijah Miller Reid, class of 1864, late 
professor of diseases of the nervous system and 
of the throat and chest, ' Baltimore University 
School of Medicine, is a prominent practitioner of 



the city of Baltimore. He is a native of Ohio, 
bom near Lancaster, Fairfield County, November 
15, IS 14, and is a son of Thomas N. and Keturah 
(Miller) Reid. His elementary education was ac- 
quired iir the schools of Baltimore. At sixteen 
years of age he entered the medical department of 
the University of Maryland from whence he was 
graduated in 1864. For a few months following 
his graduation he practiced medicine, then having 
passed the examination of the Army Medical 
Board, he entered the United States Army as an 
acting assistant surgeon, and was assigned to Co- 
lumbia College Hospital, and later was stationed at 
Armory Square and Lincoln Hospital, Washing- 
ton, 1). C. 

After his service in the amrv. Dr. Reid estab- 
lished himself on the Reisterstown road, in Balti- 
more county. In 1869 he returned to the city of 
Baltimore, where be has since resided. In 1888 
he accepted the chair of physiology, hygiene and 
diseases of the throat and chest in Balitmore Uni- 
versity School of Medicine, in which chair he re- 
mained until 1892, when he was transferred to 
the chair of diseases of the nervous system and 
the throat and chest. In 1906 he resigned his 
professorship. In 1887-88 he was chairman of the 
section on medical jurisprudence of the American 
Medical Association. Doctor Beid married No- 
vember 9, 1887, Mary A. Allen, daughter of John 
Allen, of Baltimore. Four children were begotten 
by this union, all of whom are now dead. 



Doctor Wirt Adams Duvall, of Baltimore, class 
of 1888, was born in Anne Arundel county, Mary- 
land, October 21, 1863. His elementary education 
was acquired in the public schools, and in St. 
John's College, department of Arts and Sciences, 
University of Maryland. In 1895 he received from 
his alma mater his M. A. degree. After leaving 
fol lege he matriculated in the medical department 
of the L T niversity of Maryland where he received 
his medical degree with the class of 1888. From i 
1890-92 he served as city vaccine physician, assist- 
anl demonstrator of anatomy. University of Mary- 
land, 1889-90; demonstrator of osteology, Balti- 
more Medical College, 1893-95; demonstrator of 
osteology. University of Maryland, 1897-98. 



General Thomas Andrew McParlin, United 
States Army, class of 1847, was born at Annapolis, 
July 10, 1825, and died in the house in which he 
was born, January 28, 1897. His parents were 
William McParlin and Cassandra Hillary Beall 



THE HOSPITAL BULLETIN 



117 



Woodward. His father was an officer in the war 
of 1812. He received his literary education at St. 
John's College, Annapolis, now department of arts 
and sciences of the University of Maryland, gradu- 
ating with the degree of B. A. in 18 L4. He gradu- 
ated from the University of Maiyland medical de- 
partment in 1847, and immediately entered the 
medical corps of the United States Army. He 
served in the Mexican War in 1848, in the Semi- 
nole War in 1856-57, and through the Civil War. 
He was medical director of General Grant's Army 
in the Richmond campaign. In 1866, at the 
recommendation of General Phil. Sheridan, he was 
brevettcd brigadier general for meritorious service. 
In 1858 Dr. MeParlin married Miss Alida Yates 
Leavenworth Roca, by whom he had four children. 
Alida. now wife of Senor Don Manuel Klguera, of 
Lima, Peru ; Agnes Cassandra; Harriet Clare, wife 
of Dr. Michael J. Sullivan, of Englewood, X. J., 
and Eleanor Beall, wife of Dr. Isaac II. E. Davis, 
of Baltimore, Md. 



Doctor Henry Merryman Wilson, a general prac- 
titioner of medicine in Baltimore for more than 
fifty-seven years, ex-president of the Medical ami 
Chiiurgical Faculty and in many other ways prom- 
inently identified with the professional life of the 
city and one of our distinguished alumni, was born 
in Baltimore, February 2, 1S-. J 'J. son of Luther 
Wilson ami Achsah Merryman, his wife. His 
early education was acquired under private in- 
struction and his collegiate at Dickinson College, 
Carlisle, Pa., where in 1848 he received the degree 
of B. A. He was educated in medicine in the de- 
partment of medicine. University of Maryland, 
graduating from there in 1851. Since that time 
he has been a prominent figure in the professional 
circles in the city of Baltimore. He became a 
member of the Medical and Chirurgical Faculty in 
1853, of which body he was secretary from 1850 to 
1873, vice-president in 1873-7-1, and president in 
1874-75. In 1886-87 he was president of the 
Alumni Association (Medical) of the U/niversity of 
Maryland. He is a trustee of Dickinson College, 
and of the Woman's College, Baltimore. On Octo- 
ber 7, 1851, Dr. Wilson married Eliza Kelso Hil- 
lingsworth. Their children are : John Kelso, 
Anna Ward, Luther Barton, Maude Hollingsworth 
and Henry Merryman Wilson, Jr. 



Lege, was born in Baltimore on the 30th of June, 
1868. His eaily education was obtained at Milton 
Academy ami Marston's University School for 
Boys and his Collegiate in the Academic Depart- 
ment of the John Hopkins University. He was 
educated for the profession of medicine at the Uni- 
versity of Maryland, graduating with the class of 
1888. Since graduating Dr. Horn has been en- 
gaged in the practice of medicine in Baltimore and 
at various times has held the positions of city 
vaccine physician, police surgeon and physician to 
the Augsburg Home for the Aged. In 1891 he 
was elected a member of the Medical and Chirurgi- 
cal Faculty. 



Thomas Melville Talbott, class of 1S?(), a native 
of Palls Cbuich, Fairfax county, Va., ex-president 
of the Fairfax County Medical Society, and a gen- 
era] practitioner of medicine of more than thirty- 
five years, was horn near White's Ferry, in Mont- 
gomery county. Va., on the 17th of October, 1818. 
He is a son of Benson and Maiia Hyde Talbott. 
lie was educated in the public schools of Mont- 
gomery county. In 1868 he entered the medical 
department id' the University of Maryland, whence 
he graduated in 1870. During his senior semestre 
he was a resident student in the University Hos- 
pital. Dr. Talbott began his professional career- 
in Baltimore, but soon afterwards moved to George- 
town, where he only practiced a few months, re- 
moving from thence to Falls Church, Va., where 
he is still, located. He is a member of the Vir- 
ginia State Medical Society. 

In 1876 he married Miss Ella Febrey, who died, 
leaving one son. Dr. Edward M. Talbott, assistant 
surgeon United States Army. In 1892 Dr. Tal- 
bott married Miss Kathleen Nburse, by whom he 
has three children, Philip M., Harold W. and 
Kathleen Talbott. 



Doctor August Horn, class of 1888, formerly 
associate professor of dermatology and diseases of 
children in the Baltimore University Medical Col- 



Doctor Joseph Smith Horner, class of 1883, of 
Hot Springs, Ark., who has been a resident physi- 
cian and surgeon of that place for the past twenty 
years, is a native of Missouri, ami was born in 
Fornersville, September 10, 1858. He is a son 
of Dr. William Hicks and Margaret Elizabeth 
(Smith) Horner. His early education was re- 
ceived in public schools and his higher education 
in Arcadia College, at Arcadia, Mo., Colorado Col- 
lege, at ('(dorado Springs, and the University of 
Illinois, where he was a student in 1876-1877. At 
the beginning of the session of 1881 he matricu- 



118 



THE HOSPITAL HL'LLHTIN" 



lated in the medical department of the University 
of Maryland and graduated with tire degree of 
Doctor of Medicine in 1883. During his senior 
year Dr. Horner Eerved as an interne at the Uni- 
versity Hospital. After entering general practice 
lie attended Eor a time as a graduate student the 
St. Louis Polyclinic. In July, 1888, lie removed 
from Bloomfieldj Mo., where he had been prac- 
ticing for five years and Located in lint Springs, 
where he has since been engaged in the practice 
of medicine, He is a member of various profes- 
sional organizations, among them being the Hot 
Springs-Garland County Medical Society, Ar- 
kansas State Medical Society, and the American 
Medical Association. He is a Mason, Knights 
Templar, a member of the Benevolent and Pro- 
tective Order of Elks, ami of the Presbyterian 
( 'hui eh. 

On June '.', 1884, Dr. Homer married Miss 
Alice Bell Buck, by whom he has five children, 
Margaret Elizabeth, Carl Horner, deceased; Helen 
Edith, Frances and William Lawrence Horner. 



Doctor William Christian Sandrock, class of 
1878, of Baltimore, former vice-presiden.i of the 
Adams County Medical Society, and former presi- 
dent of the New Oxford School Board, both Penn- 
sylvania Institutions, was born in Baltimore, Octo- 
ber 2, 1854. Having received his literary educa- 
tion in the public schools and Knapp's Institute, 
he entered Maryland College of Pharmacy, now 
the department of Pharmacy of the University of 
.Maryland, whein-e he was graduated with the de- 
gree of Ph.G. in 1875. He then matriculated 
in the medical department of the I adversity of 
Maryland and graduated from there with the de- 
gree of Doctor of Medicine in 1878. Doctor 
Sandrock immediately after graduation entered 
upon the practice of medicine in Adams county, 
Pennsylvania. 



In 1889 he returned to Baltimore and has since 
practiced in this city. In 1890 he became a mem- 
ber of the Medical and CKirurgical Faculty. 



In your notices of marriage you might add that 
of Dr. Jolin 1'. Young, of Richburg, S. ('., to Miss 
Constance Witherspoon, of Lancaster. S. ('.. on 
June 23rd, 1909,." 

Tin: Bulletin congratulates Dr. Young and 
wishes him much happiness and success in life. 

Through an unfortunate oversight on the part 
of the printer, the Closing sentences of Prof. 
Chew's paper published in the duly 15th number 
of The Bulletin were omitted. They are here- 
with presented : 

There is however one special case, and a very 
serious one, too, with which physicians are not in- 
frequently confronted; it is the knowledge of the 
existence of specific disease in one who* is or has 
been recently under the physician's care, and who 
is contemplating marriage within the time in which 
it would be improper. In such a case, if the 
warning counsel of the physician with a pure 
statement of what may be the consequences should 
In disregarded, so that misery and wretchedness. 
corruption of body and ruin of mind may be im- 
pending over an innocent person, the parents or 
other friends of the one endangered should be in- 
formed, for otherwise the physician could be justly 
regarded as an accessory heroic the fact with 
guilty knowledge. I have endeavored to give some 
illustrations of what should be our ethical course 
of action in varying cases, and I may say in con- 
clusion that the best ethical guide in all cases and 
under any circumstance's may be found in these 
woids from the Divinist lips: "All things what- 
soever ye would that men should do to you. do 
ye even so to them." 



Dr. J. P. Young, of Richburg, S. ('.. writes. 
"The Bulletin is always a welcome visitor to my 
home, ami I wish for it a long life and increasing 
usefulness. 



DEATHS, 

Doctor William II. Whitehead, class of 1870, of 
■Rocky Mount, X. ('.. died in Raleigh, June 25, 
1909, of paresis. In Ins .hath the State of North 
Carolina has lost one of her best citizens and the 
medical profession an honored member. Doctor 
Whitehead has held many places of honor and 
tiust. He was at the time of his death, an hon- 
orary fellow of the North Carolina State Medical 
Society. From 1890 to ism; he was a member 
ami president of the North Carolina State Hoard 
of Medical Examiners; from 1 '.hi l to 1905 a 
member of the State Board of Health; in 1885 
vice-president of the Medical Society of the State 
of North Carolina, lie was also a member of 
the Hoard of Directors of the Central Hospital 



THE HOSPITAL BULLETIN 



119 



for tlic Insane at Raleigh; Since I880, when be 
passed the examination of lieensenr lie lias befell 
actively engaged in the practice of Ins profession 
in the State of North Carolina. He spent his 
early professional career in Baltimore. In 1892 
he located at Rocky Mount, where for years be was 
division surgeon and adjuster of damages for the 
Atlantic Coast Line Railway. He enjoyed a large 
and lucrative practice, was greatly loved by all 
with whom he came in contact and stood high in 
the esteem of his fellows. In chronicling the death 
of Dr. Whitehead, the Old Dominion Journal of 
Medicine and Surgery, duly, 1909, gave voice 'to 
the following sentiments: 

"In the death of Doctor William Henry White- 
head, of Rocky Mount. X. ('.. on Thursday. July 
1st, 1909, the medical profession of the South has 
suffered a great loss. Unusually strong both men- 
tally and physically, he was acknowledged a leader 
among men. A useful citizen, he was ever ready 
to give his aid where worth was recognized, and 
many a successful man owes his position to the 
helping hand extended to him while struggling 
for an education. Whole-souled, of a bright and 
sunny disposition, he carried cheer into many a 
home darkened by the shadow «>f suffering. Dis- 
tinguished among his confreres of the South, he 
was a wise, conservative and skillful physician. 

"Doctor Whitehead was horn in Edgecomb coun- 
ty. North Carolina, in 1850. His parents belong- 
ing to the oldest and best families of that com- 
munity, gentle breeding was his by inheritance, 
and lie was taught early that high standard of 
morals and rectitude to which he so rigidly adhered 
dining his entire life. An intense lover of na- 
ture, he was as a boy able to study and enjoy it to 
the utmost in the woods and by the gently flowing 
streams of his eastern home. Actively engaged in 
the cultivation of his father's farm, he gained a 
knowledge and experience in agricultural life that 
served many useful purposes in his after life. Here 
he learned to appreciate the dignity and nobility 
of human labor, and also the proper respect and 
sympathy for the laboring man. The care of ani- 
mals intensified the spirit of innate kindliness and 
pity, not only for the helpless dumb beast, hut in 
after years for his fellow man. Very much id' his 
success in life can he attributed to the lessons in 

ec my and industry learned during these early 

days on the farm. 

"At the age of nineteen he commenced the study 
of medicine, and graduated from the medical de- 
partment of the University of Maryland, in the 



elass of 1870. He practiced in Battleboro and 

gained an enviable reputation as a practitioner and 
surgeon. In 1891 he accepted the position of chief 
snrg i to the Atlantic Coast Line Railroad Hos- 
pital in Rocky Mount, where he resided up to his 
death. He was local surgeon to the Southern 
Railway, and consulting surgeon to the I'ittman 
Sanitarium in Tarhoro, North Carolina. His death 
occurred at Raleigh, where he had been under 
treatment for some time. 

"We of Virginia envy our sister State in thus 
pioducing so splendid a type of the "True Physi- 
cian," and share with her the sorrow of his loss." 



.John Woolf Burton, M. D., University of Mary- 
land, Baltimore, 1865; Washington University, 
Baltimore, 1872; for many years a member of the 

Medical Society of the State of North Carolina; 
committed suicide at his home in High Point, 
dune 30, by hanging himself in his stable, while 
mentally irresponsible from ill health and despond- 
riicv. aged 65. 



Richard Benbuiy Creecy Lamb. M. I.)., Uni- 
versity of Maryland, Baltimore, 1904; of Yslita, 
Texas; died in Providence Hospital, El Paso, 
Texas, dune 22, from typhoid fever, aged 26. 



MARRIAGES. 

Doctor .1. P. Young, a prominent physician of 
Richburg, S. ('., class of 1894, was married to 
Miss Constance Whitherspoon, of Lancaster, S. C, 
dune 23, 1909. The wedding took place at the 
home of the bride's brother, Mr. Marion Wither- 
spoon, in Lancaster. Soon after the ceremony the 
bride and groom left for an extended bridal tour 
in the North. Upon their return they will make 
their future home in Richburg. 



Doctor John W. MacConnell. class of 1907, of 
Davidson, X. C, formerly resident physician in 
the Presbyterian Eye. Ear, Nose and Throat Hos- 
pital, of Baltimroe, was married Wednesday, July 
28, 1909, to iliss Agnes H. Doyle, daughter of 
Mr. and Mrs. A. Courtney Doyle, by Reverend D. 
D. Douglas, pastor id' Maryland Avenue Presby- 
terian Church, at the residence of the bride's par- 
ents, Chestnut avenue and Eleventh street. Wal- 
brook, Baltimore. Md. After the ceremony Dr. 
and Mrs. MacConnell left for a trip North. They 
will make their home at Davidson, X. ('. 



i 


wntthfu* 


mMvrw 




(Inflammation 's 


Antidote) 




I £ 


applied from ear to ear as hot as can be 
born comfortably by the patient, depletes 
the enlarged lymph glands, guards against 
the passage of toxines into the circulation 
and reduces the liability of Mastoiditis, 
Middle Ear and Laryngeal complications in 
Tonsilitis, Scarlatina, and other diseases of 




similar nature. 




The dressing of Antiphlogistine must 
be at least an eight of an inch thick, cover- 
ed with a plentiful amount of absorbent 
cotton and held snugly in place by a band- 




f^^J '"'' £&'' 1^' 


age. 


^m***^ •*. 




THE DENVER CHEMICAL 


^•■■J 


^SS0^^ 


MFG. CO. New York 




ERTAIN 23 it is that a single acting cause can bring 
about any one of the several anomalies of menstrua- 
tion, just so certain is it that a single remedial agent 
— if properly administered — can effect the relief of 
any one of those anomalies. 

<J The singular efficacy of Ergoapiol (Smith) in the 
various menstrual irregularities is manifestly due to its prompt 
and direct analgesic, antispasmodic and tonic action upon the 
entire female reproductive system. 

<J Ergoapiol (Smith) is of special, indeed extraordinary, value in 
such menstrual irregularities as amenorrhea, dysmenorrhea, 
menorrhagia and metrorrhagia. 

<§ The creators of the preparation, the Martin H. Smith 
Company, of New York, will send samples and exhaustive 
literature, post paid, to any member of the medical profession. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 

PRICE ^l.OO PER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter. 



Vol. V 



BALTIMORE, MD., SEPTEMBER 15, 1909. 



No. 7 



THE PROFESSOBS OF SURGERY IN THE 
UNIVERSITY OF MARYLAND. 



]'>v Randolph Winslow, M. D. 



No. 1. 



)iix Bealb Davidge, A. M., M. D. 



In the first hundred years of the existence of 
the University of Maryland there have been seven 
professors of surgery — lohn B. Davidge, William 
Gibson, Granville Sharp Pattison, Nathan 1!. 
Smith, Christopher Johnston, Louis McLane 
Tiffany and Randolph Winslow. 

1 desire to present short sketches of my pre- 
decessors in the surgical chair in order that our 
si u dents and graduates may have some knowledge 
of those who have filled this chair, from the be- 
ginning of the school to the present time. These 
sketches will contain nothing original by me, but 
are merely condensed histories taken from "The 
History of the University of Maryland/' written 
by Prof. E. F. Cordell. These men have all been* 
distinguished in their day and generation and 
have rendered important and valuable services in 
the cause of humanity and of science. The first 
of these is 

John B. Davidge. 

The charter for the founding of the College of 
Medicine of Maryland was granted by the Legis- 
lature on December 18, 1807. In the 16th sec- 
tion of this charter it is enacted that .John B. 
Davidge, M. D., and James Cocke, M. D., shall 
be joint professors of anatomy, surgery and physi- 
ology. In the division of this work Dr. Davidge 
delivered the lectures on surgery until 1812, when 
Dr. William Gibson was elected professor of 
surgery, and held the chair until 1819. Dr. 
Davidge during that period conducted the courses 
of instruction in anatomy. From 1819 to 1821 
Dr. Davidge discharged the duties of both the 
surgical and anatomical chairs, when Granville 
Sliarpe Pattison was elected to the chair of sur- 
gery. In 1826 he again took up the duties of 
the chair of surgery, upon the resignation of Pro- 



fessor Pattison. He relinquished the chair in 
L827, when Dr. Nathan R. Smith was elected 
professor of surgery. 

Dr. John B. Davidge was horn in Annapolis 
in 1768. His father died whilst he was still 

young, and he became reduced in circumstances. 
but with some assistance he was enabled to enter 
St. John's College and obtained therefrom the 
degree of A. M. in 1789. He began the study of 
medicine with the Drs. Murray, of Annapolis, 
and later entered the University of Edinburgh, 
but took his degree of Doctor of Medicine at Glas- 
gow University, Scotland, on the 22nd of April, 
1793. lie married a Scotch lady and practiced 
a short time in Birmingham, England, hut soon 
returned to Maryland, and settled in Baltimore 
in August of 1796. A severe epidemic of yellow 
fever prevailed in the city in 1797, and Dr. 
Davidge formed very definite opinions in regard 
to the origin of this disease, and came near being 
the discoverer of the causation of the disease by 
means of the bite of infected mosquitoes, which 
discovery has since made the names of Walter 
Reed and James Carroll and Jesse Lazear famous. 
Dr. Davidge published his views on yellow fever 
in 1798, in a volume which attracted considerable 
notice. In 1802 he began to give private courses 
of instruction to medical students, which were 
continued until 1807, when, being associated with 
Drs. Cooke and Shaw, his private school became 
the College of Medicine of Maryland, which later 
became the University of Maryland. Dr. Davidge 
thus became the founder of the University of 
Maryland and was known as the Father of the 
University. He was twice married, the first time 
as stated to a Scotch lady. Miss William Stuart, 
and after her death, to Mrs. Rebecca Troup Polk, 
of Harford county, Maryland, who survived him 
with four children, a son by his first wife, and 
three daughters by his second. Professor Davidge 
is said to have been a short man, with blue eyes 
and a ruddy complexion aud homely features. He 
was neat in his dress and dignified in his man- 
ner, and acquired a large practice in the < 'ii\ 



122 



THE HOSPITAL BULLETIN 



of Baltimore. He was a person of great influence 
in the medical profession of the day. and though 
of somewhat irritable disposition, he was much 
regarded by his acquaintances, and held in high 
esteem by his students. He was an excellent lec- 
turer, and a diligent student, hut was an obscure 
writer, and expressed himself in pompous and 
confusing language. Surgery was at this time 
more or less in its infancy, and the surgeons were 
also practitioners of medicine. He performed, 
however, several important operations, such as 
total extirpation of the Parotid Gland, ligation 
of the Gluteal Artery for aneurism, and ligation 
of the Carotid Artery for fungus of the Antrum. 
He also invented a new method of amputation, 
which he called the American. Hi' wrote a trea- 
tise on yellow fever in 1798, a treatise on am- 
putation in 1818, and edited Bancroft on fevers 
in 1831, and was besides a frequent contributor 
to the medical and scientific journals of his day. 
He died at his residence on Lexington street, on 
the 23rd of August, 1S29, the cause of death 
being a malignant growth of the face, originating 
in the Antrum. The disease was first noticed in 
June, 1829, and grew rapidly and was accom- 
panied with great suffering. At this late period 
in the history of the University a memorial has 
been established to him by renaming the recently 
acquired Calvary Church, which is now used as 
a library and Y. M. C. A. building, Davidge Hall. 



LEUCORRHOEA. 



By Hugh W. Brent, M. D., 



Instructor in Gynecology, University of Maryland. 

The importance of leucorrhoea as a symptom 
(if pelvic diseases finds no place in the mind of 
the average woman — to her "whites are whites," 
and that settles the question unless the co-existent 
disease be of such character as to attract her 
attention through the medium of pain, the dis- 
comfort of "profuseness" or the sometime result- 
excoriation of the vulva and adjacent skin sur- 
faces. 

Woman unenlightened, regards the symptom as 
a disease and through ignorance fails to properly 
interpret the subtle warning in an intelligent way. 
And why should she not he ignorant? — as ignor- 
ani as we may he of astrology or Hindu magic. 



Vnii see it doesn't happen to he in her line to 
know Hi,, "why" ami "wherefore." She looks to 
the physician to ferret out the seat of evil and 
"properly interpret" — you sec it happens to be 
our business tu understand these things, to look 
beyond "whiles are whites." To blithely prescribe 
hot douches for "that vaginal discharge" may be 
a procedure beyond reproach or it may be dan- 
gerous, irrational and useless, a trio certainly de- 
sen ing consideration if one is to practice Medi- 
cine nut medicine. 

The causes of leucorrhoea are myriad and un- 
til we have solved its raison d'etre with at least 
reasonable certainty we are not justified in at- 
tempting its correction. True the cause is often 
difficult of discovery, but in the majority of cases 
painstaking examination will reveal the under- 
lying pathologic process, and we will be enabled 
to establish a rational line of treatment. It may 
lie well to first briefly consider the normal physi- 
ologic secretions of the genitalia derived from the 
glandular systems of the vulva, Bartholin's glands, 
Skene's glands, the cervix and corpus uteri. The 
vagina closely approaches the skin in structure 
and is practically non-secretory though a few iso- 
lated glands are occasionally found in this local- 
ity. Its surface is bathed in the uterine and 
cervical secretions, thickened with desquamated 
vaginal cells and rendered acid through the nor- 
mal presence of non-pathogenic acid producing 
organisms, notably the Bacillus Vaginalis of 
Doederlein. In health is varies considerably in 
amount and is much increased during pregnancy 
when the cervical glands are especially active and 
the cycle of cellular life in the vaginal mucosa, 
hastened through the impetus of increased nutri- 
tion, increases the amount of cellular debris. Espe- 
cially (lining the latter part of pregnancy one 
may expect to encounter a rather profuse vaginal 
discharge, which is in no way pathologic. 

The vulva is generously supplied with sweat 
and sebaceous glands, their activity varying with 
(he individual and the seasons. The normal se- 
cretions of the vulva may, however, in uncleanly 
women become through accumulation and decom- 
position a source of irritation. Bartholin's vulvo- 
vaginal glands pour out on cither side of vaginal 
outlet, through ducts opening in front of the 
hymen a thin, transparent mucoid secretion de 
signed as a lubricant during coition. When not 
influenced psychically they are almost quiescent — 
and very naturally so. Their function has to 



THE HOSPITAL BULLETIN 



123 



do with sexual activity and it is only under the 
influence of sexual excitement that they become 
functionally active. Secretion at this time may 
be extremely profuse, but should be ever borne 
in mind as entirely normal, the amount varying 
with the intensity of the individual's desire. 

Skene's glands, situated on either side of the 
urethra, empty their secretion on the inner aspect 
of the labial urethrae, their function is the lubri- 
cation of the urethral orifice and their small size 
renders them insignificant (even when infected) 
as a source of discharge. 

The secretions of the clitoris are so slight in 
health as to escape notice, an adherent prepuce 
or uncleanliness may however give rise to more 
(>]• less trouble of an irritative character. 

We come now to the two most important, glandu- 
lar systems associated with the production of leu- 
corrhoea — those of the corpus uteri and cervix. 
Their secretions differ very essentially and it is 
often p issible to determine the source of discharge 
by the physical characteristics of the secretions. 

The cervical glands tortuous and deeply situated 
evolve a clear viscid alkaline mucous — the uterine 
glands much less complicated in structure, secrete 
a thin, setoits alkaline fluid, destined to moisten 
the uterine mucosa, but having as one of its 
principal functions the prevention of clot forma- 
tion in the menstrual blood. 

Before considering the pathology of leucorrhoea 
1 wish to mention the normal premenstrual in- 
crease in glandular activity, under the stimula- 
tion of premenstrual pelvic congestion. This 
period of hypersecretion, if I may term it such, 
is directly responsible for the widespread belief 
among the laity that menstrual blood is produc- 
tive of gonorrhoea] infection, i. e., the menstrual 
blood of a healthy woman. This of course is ab- 
surd, hut it is well to hear in mind that women 
are especially likely to transfer the disease at this 
time, for the following reason: Hypersecretion 
tends to "bring out" organisms lying quiescent 
in the depths of a gland and the woman may 
(bus become actively infectious, though exhibiting 
a comparatively slight tendency toward transfer- 

ei f the disease during the inter-menstrual 

period. 

The Pathology, of Leucorriioea. 

Genera] Svstemic Disease. 

Pelvic Congestion. 

Uterine Malposition. 

Foreign Bodies. 



Cancer of the Cervix ami Corpus Uteri. 
Genital Tuberculosis. 

Puerperal Infections and the Traumata of 
Labor. 
( fonorrhoea. 

The influence id' extra-genital diseases in the 
causation of leucorrhoea is indefinite and infre- 
quent — the popular assumption that •'whites" are 
the result of "weakness" (whatever that may be) 
is merely a confession of ignorance. With the 
exception of the possible influence of chronic con- 
stipation and such lesions of the heart, lungs, 
liver or kidneys that may cause stasis of the pel- 
vie blood supply through circulatory obstruction, 
we may practically disregard extra-pelvic affec- 
tions as etiologic factors. 

Pelvic congestion from whatever cause is a pro- 
lific source of "vaginal discharge." As the gross 
lesions of the pelvis causing congestion will be 
considered later it may be well to discuss here an 
element of psychic origin that plays no small part 
in this relation. Sexual excitement without grati- 
fication is entirely unnatural from the view point 
of the animal organism. The natural law of sex- 
ual relation demands that libido-sexualis, with its 
attendant pelvic congestion and nervous excita- 
tion be followed by completion of the sexio-erotic 
cycle through natural coitus with orgasm. If 
for any reason, physical, social, moral, or mar- 
ital, there is continual violation of this basic prin- 
ciple we' may expect to find in the woman the 
usual concomitants of chronic pelvic and ovarian 
congestion — pain, reflex nervous phenomena and 
leucorrhoea, a leuchorrhoea entirely unrelievable 
by local applications "to the womb" or the famous 
''hot douche." 

Uterine malposition, especially retro-displace- 
ment and prolapsus, are often accompanied by 
venous stasis in the uterus, and its almost in- 
e\ itable sequence — endometrial hypersecretion. 

Foreign bodies whether pessaries or the instru- 
ments of masturbation may cause vaginitis or ul- 
ceration of such degree as to give rise to profuse 
"vaginal discharge." 

Genital tuberculosis usually affects not only the 
uterus but the adnexa and pelvic peritoneum as 
well, unless the bacillus can lie demonstrated in 
the discharge or the characteristic lesions recog- 
nized microscopically in uterine scrapings, a posi- 
tive diagnosis can rarely bo made. Of course 
where salpingitis is coexistent an abdominal sec- 
tion reveals the true state of affairs. 



124 



'HE HOSPITAL BULLETIN 



I n malignant disease of the uterus the firstdis- 
charge noted is clear and watery, the producl of 
congestion and the new growth. This watery dis- 
charge associated with monorrhagia or metrorrha- 
gia occurring ahoul the menapause should at mice 
excite suspicion of cancer and is an indication 
for immediate and searching investigation. We 
must ever bear in mind in this connection that 
cancer, though commonly considered as occurring 
rather late in life, is sometimes met with in young 
women. As the disease progresses and necrosis 
with ulceration occurs the discharge becomes thick, 
corrosive and fetid, parametria! invasion has 
taken place and the golden opportunity for radi- 
cal extirpation of the growth is a thing of the 
past. In the pathologic causation id' leucorrhoea 
we may consider the traumata and infections of 
labor ami the puerperium as playing a role second- 
ary only to gonorrhoea] invasion of the genital 
tract. 

Cervical laceration with infection is a common 
cause of "discharge" and may he the single lesion 
in a profuse leucorrhoea. Even iir those eases in 
which no discoverable laceration exists, minor 
tears in the mucosa and musculature of the cer- 
vix within the canal, may become infected during 
the puerperium, tin' only clinical evidence of their 
existence being the characteristic mucopurulent 
discharge and associated erosion of the porti vag- 
inalis. Inflammation of the endometrium is not 
as common as one might think and when it does 
occur is not likely to he of long duration. We 
do indeed often encounter a discharge in child- 
hearing women, the product of the endometrium, 
hut this is in most cases a hypersecretion brought 
about by congestion dependent upon subinvolution 
or displacement, or both. 

Acute puerperal infections may or may not be 
accompanied by leucorrhoea. though as the dis- 
ease advances it always makes its appearance and 
may be very profuse. The etiology is found in 
endocervicitis, endometritis, metritis, salpingitis 
and pelvic peritonitis; either of these is sufficient 
or the entire group may be coexistent. 

The leucorrhoea accompanying a puerperal 
salpingitis differs little from that seen in tubal 
inflammation of gonorrhoea] origin with the ex- 
ception of the possible demonstration of the 
gonococcus. The discharge in salpingitis is usu- 
ally directly dependent upon the chronic pelvic 
congestion associated with pelvic inflammatory 



disease. Of course in some cases there is an as- 
sociated endometritis. 

That occasionally drainage does occur through 
the uterine end of the tube is not to lie denied, 
hut it is very rare. Inflammatory thickening of 
the mucosa in this the narrowest portion of the 
canal, effectually prevents the extrusion of the 
products of inflammation into the uterine cavity. 

hi hydrosalpinx which is usually of inflam- 
matory origin we occasionally encounter the so- 
called •'Hydrops Tubae Profluens," in which the 
tube periodically empties itself by way of the 
uterus. The condition is comparatively rare and 
is probably due to causes other than pre-existent 
pyosalpingitis. 

The point of importance in tubal disease is, 
that it is folly to tieat minor conditions in the 
cervix and uterus without bimanual pelvic exam- 
ination. Jf one lie guilty of this indiscretion be 
may expect often to miss the true source of the 
leucorrhoea — "higher up." 

Gonorrhoea is by far the most important etio- 
logie factor in genital discharge, not only because 
of its frequency, but through the extremely serious 
consequences resulting from failure to recognize 
this disease. Gonorrhoea in the female is diffi- 
cult to combat when one fully realizes its power 
for harm and is thoroughly competent and con- 
scientious in its treatment. The existence of such 
a malady is sufficient in itself to demand of every 
physician worthy of the name a searching in- 
vestigation when he is called upon to treat "that 
little discharge." Infection of the entire genital 
mucosa and glandular system is not uncommon 
in acute gonorrhoea, but as the disease becomes 
chronic there is a tendency toward localization in 
cei tain areas, noticeably Bartholin's glands the 
cervical and corporeal endometrium and the fal- 
lopian tubes. In these structures it may remain 
semi-latent for years — a source of discomfort and 
leucorrhoea to the woman and a potent factor in 
the dissemination of the disease through pros- 
titution. Clinically, the discbarge in gonorrhoea 
is characteristic, viewed by the experienced eye. 
But before making a diagnosis it is preferable 
to demonstrate the gonococcus — the best "smears" 
being obtainable from the urethra and Bartholin's 
gland-. 

Leucorrhoea is a vast subject and the author 
appreciates the woeful deficiency of such a brief 
paper. If. however, he has made plain that 
''vaginal discharge" is always due to some specific 



THE HOSPITAL BULLETIN 



125 



lesion usually discoverable through painstaking 
examination and that only through treatment of 
the cause can one hope to be successful in its 
cure — be will feel that the time consumed in the 
preparation of this aiticle has been well em- 
ployed. 

3124 Mai viand Avenue. 



A CASE OP FRACTURE OF THE CLAVICLE 
WITH PECULIAR SYMPTOMS. 



By Everette Iskmax. '09, 



Senior Medical Student. 

Fracture of the clavicle is the most common of 
all fractures, and the symptoms are usually 
characteristic but in some exceptional eases, the 
clavicle may be fractured without presenting the 
usual symptoms. A ease of tins character came 
recently under our observation. 

Case — (!. K., white, age 16 years, a sailor by oc- 
cupation, was admitted to the University Hospital 
on January 19, 1909. Four days previously whilst 
going down a ladder on shipboard, he slipped and 
fell about five or six feet, striking his head first 
and then his left shoulder. He was able to get up 
but found that his left shoulder pained him a little. 
This was about 8 o'clock in the evening, about 4 
o'clock in the morning lie awoke with a great deal 
of pain in the shoulder and the ship's doctor was 
called and examined him, and pronounced the in- 
jury a bruise. The arm was put up in a bandage 
which gave him relief from pain. Two days later 
the bandage was removed and the hoy could move 
his arm in any direction without pain, and could 
also put his hand on his head, and swing his aim 
backwards and forwards without discomfort. Upton 
reaching Annapolis, he was examined by one of 
the surgeons of the Naval Academy, who also did 
not think that there was a fracture, hut recom- 
mended sending him to Baltimore to a hospital, as 
the boy was unable to work. When he was ad- 
mitted to the University Hospital, a lump was 
found in the middle of the clavicle but the boy 
could move the arm in any direction without pain, 
he could also put the hand of the injured side upon 
the top of his head without the least difficulty, 
hence it was thought by the physician who ad- 
mitted him that the injury was a bruise and not 
a fracture. The next day when Professor Winslow 
made his rounds of the wards, the case was called 



to his attention, and he found, as has been stated, a 
lump over the middle of the clavicle, which was not 
tender upon pressure but was discolored from con- 
tusion. Upon manipulating the parts it was pos- 
sible to get distinct motion and crepitus at this 
point, and it was evident that a fracture was 
present at the middle third of the collar hone. The 
hoy was perfectly able to place his hand on the top 
of his head without inconvenience, and could 
readily move his arm in any direction. He was 
placed upon the table with a pillow between his 
shoulders causing the shoulders to he thrown back- 
wards and the left arm was abducted and rotated 
outward. Whilst in this position a plaster cast 
was applied to his chest and arm, fixing the arm 
in this position, with firm pressure upon the point 
of fracture. The east was comfortable to the 
patient ami was not removed until February 25, 
when firm union was found to have taken place, 
witli hut slight deformity. One of the charac- 
teristic features of a broken collar hone is the 
absolute inability of the patient to execute the 
ordinary movements of the arm or to put the hand 
upon the top of the head. Deformity is usually 
present at the seat of fracture, as was the ease in 
this instance; usually there is no displacement or 
deformity in a case of fracture of the clavicle, when 
the break is situated about one inch from the outer 
extremity <d' the bone. Running from the coracoid 
process to the under surface of the clavicle are two 
ligaments known as the conoid and the trapezoid 
ligaments. When a fracture of the collar hone oc- 
curs about one inch from its outer extremity, the 
line id' fracture lies between the conoid and trape- 
zoid ligaments and there is no displacement of the 
fragments. In all other forms of fracture of 
this bone there is both displacement and deformity. 
Sometimes with this form of fracture the person 
may he able to use the arm though usually with 
difficulty. 

Another ease occurring in the practice of Pro- 
fessor Winslow, illustrating these points, was that 
of a colored woman, who having an altercation 
with her husband, was thrown by him against the 
door, injuring her shoulder. When seen the 
woman was ironing clothes, though with pain, and 
she could also place her hand on her head. There 
was absolutely no displacement of the bones and 
no deformity, but when the shoulder was carefully 
examined distinct crepitus could he felt at the 
outer extremity of the clavicle, showing that a 
fracture had taken place. I have reported these 



126 



THE HOSPITAL, BULLETIN 



cases as they are unusual, and serve to show that 
variations occur, and hence the necessity of making 
careful examinations in all cases of fracture aboul 
the neck and shoulder as well as in all other 
regions of the body. 



ABSTRACTS. 



IS PUBIOTOMY A JUSTIFIABLE 
OPERATION? 

J. Whitridge Williams, class of 1888, Johns 
Hopkins University. (American Journal of 
Obstetrics.) 

"Thus, assuming that the figures given above 
are approximately correct and thai two series of 
l 3 000 cases of moderately contracted pelves were 
treated by pubiotomy and the induction of labor, 
respectively, il would appear that the former opera- 
tion would be required in fifty and the latter in 
250 women; and that if the maternal mortality 
were, respectively, 2 and 1-3 per cent, the num- 
bers of deaths would be identical in both series. 
On the other hand, admitting that the fetal mor- 
tality were 10 and 25 per cent., respectively, five 
children would be lost in the former and sixty-two 
in the latter series. Or. to put the matter more 
forcibly, a greater number of children would have 
been saved had craniotomy been perforemd in all 
cases in which pubiotomy was indicated." 

"Naturally, it might be suggested by the advo- 
cates of the induction of premature labor thai such 
calculations are not convincing. That they are 
not purely speculative, however, is demonstrated 
by the figures recently adduced by Burger, which 
are based upon analysis of 1.0.000 labors occurring 
in Schauta's clinic in Vienna. In this series there 
were -I. ".MO contracted pelves with a fetal mortality 
of only 22 per cent, in the cases in which spontane- 
ous labor occurred ; whereas it rose to 4.3 per cent, 
in cases treated expectantly, including all deaths 
following craniotomy, pubiotomy, and Cesarean 
section. Results which cannot be approximated by 
the most enthusiastic advocate of the induction of 
labor." 

"Having shown that pubiotomy is superior to 
the induction of labor and symphyseotomy, it re- 
mains to consider to what extent it enters into 
competition with Cesarian section. In the first 
place, il must be stated that the former operation 
is not indicated when the conjugata vera measures 
less than "> cm. Consequently there can be no com- 
petition in the pelves above thai limit; namely, 
in the so-called "border-line" cases, in which it is 



generally impossible to predict the outcome of 
labor in any given case. Moreover, it must be ad- 
mitted that if the decision were based entirely 
upon the general mortality of the two operations, 
it would have to be given in favor of pubiotomy, 
as an analysis of the reports of the best operators 
shows that the average mortality in Cesarean sec- 
tion is in the neighborhood of 5 per cent." 

"The researches of Reynolds, however, indicate 
that this figure does not altogether represent the 
true slate of affairs, but that, admitting the com- 
petence of the operator and the excellence of his 
technic, the results will vary greatly according to 
the period of labor at which the operation is per- 
formed. Thus, in an analysis of 289 eases, he 
found that the mortality was 1.3, 3.8 or 12 per 
cent., respectively, according as the operation was 
performed dining the last days of pregnancy, or 
early or late in labor. As his results are in ac- 
cordance with my own experience, I feel justified 
in holding that the results of Cesarean section per- 
formed just before or at the very onset of labor 
are superior to those of pubiotomy. both as regards 
the actual mortality and ease of convalescence of 
the mother, not to mention the fact that all of 
the children are saved, instead of only 95 per 
cent., as in pubiotomy. On the other hand Cesar- 
ean section performed early in labor has a some- 
what greater mortality than pubiotomy; while if 
not resorted to until the second stage is well ad- 
vanced there can be no comparison between the 
two operations, as the former has a mortality of Id 
or 1".' per cent, and the latter of only 2 per cent. ' 

"Accordingly, if it were possible to predict in a 
given case that engagement would not occur, the 
best interests of both the mother and child would 
be served by performing Cesarean section at an 
appointed time a few days before the expected date 
of confinement ; as by so doing the child would cer- 
tainly be saved, with a minimal risk and an al- 
most ideal convalescence for the mother. Un- 
fortunately, in the class of pelves under considera- 
tion, such a prediction is never possible in women 
pregnant for the first time and only exceptionally 
in multiparae. Therefore, in primiparae, Cesar- 
ean section would not be indicated at the time of 
election, unless one were willing to assume the 
responsibility of operating unnecessarily upon a 
considerable number of women when one knew by 
experience that a large proportion of them would 
be delivered spontaneously if subjected to the lest 
of labor. For this reason, early elective Cesarean 
section would be justified only in multiparae in 



THE HOSPITAL BULLETIN 



127 



whom the history of previous labors had clearly 
indicated that nature was habitually unable to 
overcome the disproportion between the size of the 
head and the pelvis." 

"On the other hand, if Cesarean section is not 
done at the very unset of labor, 1 consider thai 
the besi interests of the patient will be served if 
she be treated expectantly, allowed to go into the 
second stage of labor, and then subjected to pubi- 
otomy, it' engagement does not occur after several 
hours id' strong pains, or in the presence of cer- 
tain conditions which indicate the necessity for 
prompt delivery." 

"To my mind, the great advantage of pubiotomy 
in tin' treatment of border-line cases of pelvic con- 
traction consists in the fact that it affords the pos- 
sibility of subjecting the patient to throes of labor 
in suitable cases and then of interfering for the 
sake of the child without subjecting the mother to 
too great danger. In other words, it enters into 
competition with high forceps, prophylactic ver- 
sion and craniotomy rather than with Cesarean 
-eei ion." 

"I desire to emphasize the fact that if good re- 
sults are too be obtained, pubiotomy should be re- 
garded as a primary operation, and should not be 
resorted to after the failure of high forceps or 
version. If delivery be urgently demanded in such 
cases, 1 feel that it is better to perform craniotomy 
than to subject the mother to any risk for the 
sake of a child whose life has already been com- 
promised. Moreover, I feel that it should not be 
employed in cases of infection, as a large part of 
the fatal results recorded in the literature have 
occurred in that class of cases." 



thin. His opinion is thai there is no warranl I'm' 
the removal of a comparatively healthy gall-blad- 
der. 



In an article in the Washington Medical Annals, 
Vol. Ill, No. 3, July, 1909, entitled "Some of the 

Perplexing Complications Found in Gall Stone 
Surgery,'" Or. I. S. Stone, class of 1872, of Wash- 
ington, O. C, lays emphasis upon the following 
points: The diagnosis of gall stone diseases is 
comparatively easy when followed by jaundice, and 
when a stone is found in the stool; otherwise it is 
difficult. He refuses to assent to the statement 
that pressure over the gall bladder with the hand 
will cause pain if stones are present. He claims 
ulcer of the stomach or duodenum give rise to 
symptoms simulating gall-bladder disease, making 
a positive diagnosis often impossible. The con- 
tracted gall-bladder has given the writer the most 
difficulty in locating both before and after opera- 



lien. Hopkins Can-. M. 0., Portsmouth, Va.. 
class, 1896, reports the following of cases of 
lupus, epithelioma, acne and nevus successfully 
in- 1 with X-ray and high frequency currents-. 

1 have nothing new to present, but desire 
to show the good results that have followed the use 
of the X-ray and of the high frequency current in 
lie above conditions, which have often proved in- 
tractable and been a source of considerable annoy- 
ance to the physician on account of their poor re- 
sponse t" the methods in existence before the ad- 
veit of these new agents. 

Lupus Vulgaris. — The patient was a woman 
sixty year.- of age, in a fair state of health. The 
pari affected was the ear and an area of two inches 
below and behind its lower border. The lobe of 
the ear had been destroyed and the ulcerative pro- 
cess was penetrating deeply at the junction of the 
ear with the head. There was intense itching and 
redness; no apple-jelly tubercules typical of this 
foi in of lupus were present; they had apparently 
been destroyed by chemical methods. This form 
nf treatment, however, has been entirely supplanted 
by the X-ray. through tin.' use of which brilliant 
results are obtained. I gave' this women seances 
of five minutes' duration, alternating the tube with 
the high frequency current every other day. After 
the first exposure the itching was entirely relieved. 
The amount of X-rays employed was just sufficient 
to lieht the tube with a greenish yellow glow; all 
the time the reaction was kept well below the point 
of active dermatitis. In this manner tissues of 
low resistance were destroyed without affecting the 
healthy stroma. By the continuous use of these 
weak exposures for a period of two months the 
ease was entirely cured. 

Epithelioma. — The patient was a woman sidy 
years old: the growth was a so-called crater-form 
epithelioma, the border being very nodular and ele- 
vated, with a sharply excavated, deep, central 
ulcer, involving the left side of the nose. In this 
case 1 used the tube exclusively; the seances were 
of eight to ten minutes duration twice a week, with 
the tube brought to a greenish yellow glow. A fter 
ten weeks of treatment a cure was affected. 

Acne in. a young man, twenty-two years old. 
llis face was covered with superficial inflammatory 
papules and pustules, associated with comedones. 



128 



THE HOSPITAL BULLETIN 



I treated him with the ultra-violet light, ami con- 
stitutional treatment was also resorted to. The 
seborrhea disappeared first; the formation of 
comedones and acne lesions gradually ceased, with 
diminution of the size of the sebaceous follicles, the 
pores becoming small, and the texture of the skin 
was entirely restored. 

Nevus in an infant, two months old. located on 
the forehead, extending from the hair to the bridge 
of the nose. It was a vascular nevus of the flat 
variety, consisting of a superficial plexus of dilated 
capillaries. I treated this by the cataphoric 
method. After painting the nevus with sodium 
thylate, it was made to penetrate the affected 
capillaries by the high frequency current. In seven 
days a scab had formed, and in twenty-one days 
I he nevus came away with the scab, leaving the 
skin in a normal condition, with the exception of a 
slight scar that was scarcely visible in thirty days. 

Psoriasis. — This was a case of the acute in- 
flammatory form of psoriasis. The lesions were 
on the extensor surfaces of both forearms, extend- 
ing from the elbow to the wrist. The eruption had 
the characteristic red base, slightly elevated, with a 
sharply circumscribed border. I resorted to the 
high frequency current exclusively, and with the 
large surface electrode made applications id' five 
minutes' duration every third day. After five such 
treatments the eruption completely disappeared. 



Rodent Ulcers of the Cornea 
(Moren's Ulcer.) 

Robert L. Randolph, class of 188-1 (J. A. M. A., 
July 2 f. 1909), is surprised that so few cases 
(thiity-five) cases of corneal nicer (Moren's) are 

reported in the literature. He believes it is due 
to a lack of recognition upon the part of the 
ophthalmologist. At first sight this corneal ulcer 
does not differ from that form which very ophthal- 
mologist sees now and again, the marginal ulcer. 
One feature which distinguishes it from any other 
ulcer of the cornea deeply undermined conjunctival 
edge of the ulcer. The edges of marginal ulcer 
an also undermined, hut owing t oa better blood 
supply not to the same extent as the borders of 
rodent ulcer. Chronicity is an important point in 
the history of rodent ulcer. Average length of 
time from two to ten months, occasionally the con- 
dition last for more than a year. 

It is a mistage to think that the affection is 
painless, for it is characterized by frequent attacks 



of suffering and irritative symptoms generally. 
The ulcer shows considerable to run close and 
parallel to the limbus of the cornea, and one of its 
peauliarities is to clear up and look as though it 
would he completely well in a few days, when a 
flesh outbreak would occur. The diseased surface 
is crescentic and hare id' epithelium, as a conse- 
quence o fwhich the fluorescin stain takes well. 
Wherever the process has spent itself the cornea is 
scarred. The disease dies out in most cases after 
the entile cornea has been involved. Usually seen 
in adults over 40. Men more prone than women. 
Its etiology is unknown. He is inclined to the 
view that it is of bacterial origin. lie believes 
after two months if the ulcer has not yielded to 
active, irritants such as the galvano cautery it si 
l.eltci to these applications ami resort to sail solu- 
I ion. atropine and tonic treatment. 



Doctor Samuel Theobald, class of 1867, in tin 1 
duly lo. 1909, issue of the Journal of the Ameri- 
can Medical Association, relates that nearly all 
the ills to which flesh is heir, have been ascribed to 
eyestrain (Reflex Aural Neuroses caused by Eye- 
strain), but scant consideration has been given to 
the influence which it exerts on the auditory ap- 
paratus. So scant indeed that he can find no 
reference to it in the titles id' papers contained in 
the Imle'x-< atalogue of the Surgeon-General's Lib- 
rary. Consequently he has felt it incumbent upon 
himself to relate his experience in the matter. In 
enumerating the less common consequences of eye- 
strain he mentions tinnitus aurium, others which 
hi has observed are a "muffled" or "stuffed" sen- 
sation in the ear, pain, not severe, impairment of 
healing. Whether vertigo associated with eye- 
strain, deserves to be regarded as an aural reflex, 
he is not prepared to say. though it seems not at all 
improbable that the derangement that gives rise 
to it is in the semi-circular canals. 

The evidence in favor of the ocular origin of the 
aural sensations enumerated is, first, their disap- 
pearance after relief of the eyestrain; second, that 
the car affected — for the sensations were com- 
monly unilateral — was usually on the side of the 
more troublesome eye; and third, that they often 
became more pronounced wben the eyestrain was 
most annoying. The ocular fault often present 
was astigmatism. 

He appends to the article the notes of four of 
the most striking of the cases which have come 
under his obsen ation. 



THE HOSPITAL BULLETIN 



129 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

EDITED BY 

A COMMITTEE OF THE HOSPITAL STAFF 



PUBLISHED BY THE 

HOSPITAL BULLETIN COMPANY 
University of Maryland 



Business Address, 
Editorial Address, 



. . Baltimore, Md. 
University of Maryland 



Baltimore, Md., September 15, 1909 



THE COURSE OF MEDICAL INSTRUCTION. 
THE IMPROVEMENTS NEEDED. 

The great amount of attention which has been 
given in recent years to laboratory instruction in 
the education of the medical student lias overshad- 
owed, in a measure, the didactic and clinical work 
which formerly made up the courses of instruc- 
tion in our medical schools. The brilliant results 
which have followed from laboratory studies, the 
scientific cast which they give to the mind of the 
student, the cultivation of his faculties of obser- 
vation and research, and clearer insight into the 
etiology and treatment of disease, have made the 
laboratory the keystone which gives support to the 
modern system of education in medicine. The lab- 
oratory has not only come to stay, but is destined 
to exercise a much larger place in the training 
of the medical student. The word laboratory 
must be considered in its broadest sense — not as 
a room equipped simply with microscopes where 
histology and pathology are studied, but courses 
of instruction conducted in anatomy, physiology, 
chemistry and clinical medicine and surgery where 
laboratory methods are employed. The laboratory 
is the place where painstaking observations are 
made, where health and disease are studied side 
by side with a scientific formula and not with 
loose and easy methods. 

The course of medical instruction is rapidly con- 
forming to the laboratory conception. The text- 
book, the didactic lecture, the quiz and the oral 
examination belong largely to the pedagogue; 
these have a minor place in the curriculum of 
the future which must consign to the junk shop 



much rubbish which is now made to take the 
place of more valuable material. Knowledge of 
many subjects, formula' ami things is not so 
much needed by the physician anil surgeon as in- 
telligence, correct judgment, scientific ability, the 
faculty of seeing and appreciating the relations 
id' things and id' arriving at practical results. 
In the education of the medical student his knowl- 
edge of subjects should be exact, but this knowl- 
edge should be of that character which is in con- 
stant use, which has direct relation to the prac- 
tice of that branch or to those branches of science 
in which he is chiefly employed. Much of the 
materia] which is now crammed into the mind 
id' the student could he and should be cut out if 
the aim of the student's future work can be as- 
certained. In every class of medical students 
there are not a few men who have definite courses 
in view; a few are destined to follow the scien- 
tific laboratory — pathological, physiological or 
chemical ; a few others specialize in medicine, 
surgery or their minor fields, whilst the larger 
majority will express their purpose of engaging 
in general practice. It seems clear that a course 
of education which holds an entire class to the 
same line of study, making no exceptions for the 
laboratory man or the clinician is following old 
and impractical methods. The time is fast com- 
ing when such systems must give way to broader 
and more enlightened views. Why postpone 
specialization in medical study until after gradua- 
tion, when it. might be inaugurated with marked 
advantage to the student during the years of prepa- 
ration for the doctorate? 

After the fundamental sciences have been well 
taught the field of work might well be narrowed 
to cut out on the one hand, or to emphasize on 
the other, those lines of work which may be un- 
necessary or necessary to the man in his future 
career. The most marked success now being made 
by men in all avocations and professions will be 
found in that class who do not possess so wide 
and varied a knowledge of many things as an 
accurate, practical and clear knowledge of the 
work in which they are engaged. 

Knowledge is not skill, nor is it wisdom. It 
is only a valuable asset when it is used skillfull)' 
and wisely. The time expended in acquiring 
knowledge will be well spent or poorly spent in 
proportion as this knowledge is made use of by 
the individual, hut a training which stimulates 



130 



THE HOSPITAL BULLETIN 



a mind to think, to observe, to judge, and to act, 
will always give an asset to the individual which 
will pass at its par value in any market. If the 
education of the student enables him to acquire 
a habit of mind which tits him to see and judge 
facts in their true relations, to know the true 
from the false, to discriminate and adjust, to have 
loyalty and mental endurance, the highest stand- 
ard of instruction has been reached. 



THE PHYSICIAN IX POLITICS. 

It is unfortunate for the medical profession 
and still nunc, we believe, for the public inter- 
ests, that I'ew physicians are found in legislative 
bodies, either state or national. These few, 
as a rule, are young men seeking local popu- 
larity, or older men retired from the active prac- 
tice of medicine or engaged in othei pursuits. 
There is an apparent antagonism between the 
active practice of medicine anil the occupancy 
of public office. The constant demands upon the 
time of the physician engaged in a busy profes- 
sional work make the holding of a public office 
a question of personal sacrifice of business which 
hut few men will agree to. The physician in 
politics must either he a man who is simply in- 
terested in public matters without holding pub- 
lic office or the man who accepts public office to 
the neglect of his professional interests. The re- 
sult of this condition of things has tended to lower 
the professional standard of the physician in poli- 
ties in the respect and confidence not only of his 
professional brothers, but of Ins patients and neigh- 
bors. There is no substantial reason why this 
feeling should exist and it is unfortunate not 
only for the medical profession, but for the pub- 
lic, that it does, since it has deprived the state 
and nation of a class of men whose training and 
experience could have been made extremely valu- 
able in the public service. It has forced the lead- 
ing members of the profession of recognized pro- 
fessional ability and large accomplishments to 
take no active part in the making of useful laws 
and in promoting the best interests of citizen- 
ship by an active co-operation in civic affairs. 

In looking over our numerous state and national 
legislative bodies one is struck with the small 
representation of the medical profession in con- 
trast with that of other professions and occupa- 
tions. Lawyers, capitalists, bankers, farmers and 



even clergymen, are more largely represented in 
these bodies than are physicians, scientists and 
educators; men who by training and mental dis- 
cipline are most eminently fitted for public lib' 
and public service. In the present Senate of the 
United States there is only one trained physician, 
and it is well known how wisely and well he has 
served the nation. In the House of Representa- 
tives one can count on his fingers all the physi- 
cians in this body ami yet find no man who has 
made distinction in his profession outside his own 
district. 

In the Cabinet we fail to find in the bmg list 
of men who have been advisers of tin President 
the name of a single physician. In the early his- 
tory of the Republic Benjamin Rush not only 
-i rved the nation with eminent ability, but was 
a distinguished ornament to the profession of 
medicine, and taught the lesson that the physi- 
cian in politics was equally skilled in the duties 
of the sick mom. He found ample time to attend 
his patients, to contribute to the literature of his 
profession and to serve the nation in the most 
critical period of its existence. 

Benjamin Franklin, philosopher, scientist and 
statesman, whilst not a physician, demonstrated 
that wide and varied talents enlisted in the pub- 
lic service gave dignity and authority not only to 
the man. but to positions he filled in public office. 

In Cteat Britain one cannot but be struck with 
the small part the medical profession has played 
in the political history of this great nation. Whilst 
Harvey, dinner. Hunter. Simpson. Lister and 
many noted men have brought great honor and 
glory to the English-speaking race, we find no 
Harvey in Parliament making laws ami no Jen- 
ner in the House of Lords contending for estab- 
lished privileges. The physician in politics in 
Great Britain has made no distinction and has 
tendered but little public service. 

In France both physician and scientist have 
engaged with striking loyalty and efficiency in 
public service and, perhaps, in no nation has the 
medical profession been more largely and ably 
represented in legislation and in administration. 
The French people have dignified both medicine 
and general science by the high regard it bestows 
upon men who became eminent as investigators 
or as leaders of thought ami action. She has 
honored with the highest public office many of 
her most noted physicians. In Germany the late 



THE HOSPITAL BULLETIN 



131 



Prof. Virehow is a striking illustration of the 
greatest of scientists and the greatest of citizens. 
It is doubtful whether his contributions to pa- 
thology, which have become the property of the 
entire world, are held in higher esteem by the 
German people than his civic virtues, his manly 
independence and profound patriotism. 

The German people know that Virchow loved 
and served Germany as much as he loved science 
and that he gave his best labors to both. With 
these general statements of conditions which have 
influenced the participation of the physician in 
politics, it is pertinent to ask whether these con- 
ditions should continue or whether the time has 
not come for larger and more liberal views on 
the subject. In an age of such progress as the 
world now enjoys men of training, of talent and 
of fitness are needed in every walk of life. The 
functions of government are becoming more and 
more complicated each day. The laws, customs 
and business interests of the people are being 
changed to meet industrial and social establish- 
ments which spring up over night and threaten the 
stability of older thought and action. This social 
and industrial evolution brings money and class 
distinction into the limelight, and makes organi- 
zation and co-operation essential to an honest 
and efficient administration in civil government. 
The men who control political parties, who make 
our laws and who govern the people are largely 
put in these positions of trust and responsibility 
through influences organized and controlled by 
corporate or personal interests. The people at 
large who vote and make majorities are, as a class, 
indifferent to general results so long as they are 
not personally disturbed in their property inter- 
ests. A law, however unjust or bad, is not vicious 
except to the individual who is prejudicially ef- 
fected by it. A high tariff is only detested by 
people who seek the benefits of the low tariff. 
In other words, the question of legislation is very 
largely determined by personal interests and con- 
siderations, and these matters usually influence 
the election of men who make our laws and govern 
our affairs. 

So long as the people, as a body, do not con- 
cern themselves in a serious way about political 
questions, just so long will legislation follow the 
channels made by personal interests. If able 
and efficient men are so much interested in their 
private affairs as to be unwilling to render public 



service, what right have they to expect personal 
consideration by men who may have their own 
persona] interests in direct conflict with theirs? 

If the medical profession desires legislation 
along lines in accord with the highest public and 
professional interest, it must assert its influence 
through persona] representation in legislative 

bullies. 

Some of its best men must be willing to make 
a personal sacrifice by accepting public office, and 
by lending their best influence in behalf of the 
highest citizenship. If the profession has no 
civic pride or loyalty and seeks to escape persona] 
responsibility in public service, it should mil 
complain if legislation does not go its way. 

Xi) body (if men is in better position to direct 
the public mind and to promote the highest stand- 
ard of citizenship than are medical men. They 
know the needs of the people and are nearer to 
the hearts of the people than any other class. It 
is up to the profession to say whether the physi- 
cian in politics shall command the co-operation 
and respect of his brother physicians when he 
consents to render a public service, or whether 
his efficiency shall lie weakened by indifference 
and adverse criticism. T. A. A. 



CORRESPONDENCE 

AMERICAN ASSOCIATION OF CLINICAL 

RESEARCH. 
Editor Hospital Bulletin, 
Dear Sir : 

There is a movement on foot to establish an 
American Association of Clinical Research for 
(be purpose, first, of ascertaining the present ex- 
act status of clinical medicine and surgery, and, 
secondly, of advancing clinical medicine and sur- 
gery, by the conjoined clinical method or any 
other method that will insure exact and abiding 
results. 

Will you have the kindness to publish the ac- 
companying open letter in the next or the earliest 
possible issue of your Journal? 

The meeting is called for October 27 next, and 
your assistance in calling attention to this meet- 
ing sufficiently early will be highly appreciated 
as an effort to help the cause of scientific medi- 
cine and surgery. 



132 



THE HOSPITAL BULLETIN 



OPEN LETTER. 
Dear Doctor: 

A meeting of physicians and surgeons interested 
in Scientific Clinical Research is called for Wed- 
nesday, October 21, 190&, at John Ware Hall. 
Boston Medical Library, No. 8 Fenway. Boston, 
Massachusetts. The meeting will come to order 
at in A. M., and carry its sessions through Wed- 
nesday, and. if necessary, through Thursday and 
Friday. 

'Flu' object id' the meeting is. 

Fust, to establish an American Association id' 
Clinical Research; 

Secondly, to establish clinical research on an 
incontrovertible scientific basis in hospitals: and 

Thirdly, to institute an American Journal of 
Clinical Research, in which the work of members 
of the American Association and of others doing 
clinical research work in a scientific manner shall 

be published. 

Yon and your friends are herewith cordially 
invited to participate in this meeting and in the 
proposed movement of scientific clinical research. 

This invitation is extended to all physicians 
and surgeons whose interest goes beyond the im- 
mediate ease work of ordinary clinical societies: 
and it is hoped that the invitation will be ac- 
cepted by all medical practitioners, irrespective 
of their present medical affiliations, who can 
appreciate the necessity for establishing on an 
incontrovertible scientific basis the certainties and 
limitations of the present practice id' medicine 
and surgery before attempting to add to the al- 
. ready large ami cumbersome field of medicine. 

The American Association of Clinical Research 
is not intended to disturb the present medical 
affiliations of its members nor to interfere in 
the very least with the duties they owe and the 
privileges they enjoy by virtue of their affiliation 
with any existing national medical body. 

The Americal Association of Clinical Research 
is to take cognizance id' the fact that the clinic 
requires cold facts and conclusive methods, and 
upon these fundamental requirements, the struc- 
ture and the work of the American Association 
of Clinical Research are to be built. 

It is of the utmost scientific importance to es- 
tablish conclusively all that is at present true 
in medicine and surgery, and only upon such 
proved knowledge, to base any further advance- 
ment. The clinic deals with clinical entities and 
not, like the laboratories, with parts as entities. 



Therefore, clinical research differs, and must 
differ, from experimental laboratory researches. 
Clinical research must consider clinical entities, 
and when considering parts, it must consider 
them only as parts and not as whole-. All that 
subserves the object id' obtaining and investi- 
gating clinical fact- and principles belongs to 
clinical research and the laboratory is a part of 
the means of clinical research, hut only a part. 
The crux of the matter appears to be that 
experimental laboratory proof is not sufficient 
clinical proof. In order to advance in an irre- 
sistible line, clinical research must be based on 
a conclusive form or method of clinical proof. 
In experimental proof, we dislocate a pari from 
a whole ami attempt to prove the whole from the 
pait. as though a dislocated part could always 
prove the whole. Or we attempt to prove facts 
in one species by facts in another species, as 
though the two species were identical. For in- 
stance, the experiments made on animals to elu- 
cidate certain elements of fever bring out a fact 
of almost insurmountable difference between man 
ami the lower animals, the fact that man has 
associated with the nakedness id' his body a highly 
perfected power for regulating his temperature, 
a highly developed vasomotor system and a vast 
array of sweat glands, a characteristic complex 
of things which apparently no other species of 
animal life presents. Experiments made on ani- 
mals to prove febrile or other clinical phenomena 
in man. may he suggestive, but for obvious rea- 
sons cannot be conclusive. To prove observations 
in man. the observations must be made on man 
and not on animals. But observations on man 
even are not necessarily conclusive. Individual 
observations on man cannot be conclusive, because 
the same experience cannot be repeated, and when 
we prove by numbers, we compare similar but 
not identical experiences. Analogy is not con- 
clusive proof. Identity alone is conclusive proof; 
but since, in medicine, identical experiences can- 
not he lepeated, we must provide simultaneous 
identical experiences in order to have proof by 
identity. Clinical proof is conclusively estab- 
lished when all observations and experiments are 
made conjointly by at least two competent men. 
preferably of opposite ideas, at the same time. 
Conjoined critical observation and experiment, at 
the bedside and in the laboratory, as may be re- 
quired, furnish simultaneous identical experiences, 
the proof proceeding on the principle that a whole 






THE HOSPITAL BULLETIN 



133 



cai] In 1 proved only by the whole and no! by dis- 
located parts. 

These and other weighty questions awail your 
assistance for a necessary solution. The benefit 
that will accrue, both to medicine in particular 
.•mil to the medical profession and humanity at 
large in general, from a satisfactory establishment 
of scientific clinical research, can be easily sur- 
mised. Come prepared, yourself and your friends, 
to give to this matter your mature convictions 
and your personal assistance. Only from a criti- 
cal interchange of critically acquired opinions, 
can we hope for clearness and for the clarifica- 
tion of the medical atmosphere now charged with 
confusion and indifference. 

Your communication, indicating your interesi 
and ymir expectation of being present at the meet- 
ing in Boston on October 27, next, is eagerly 
awaited, and on receipt of the expression of your 
inteiert, further developments will be communi- 
cated to you personally in due time. 

1'lease addiess your communications at tlic 
earliest possible date directly to dames Krauss, 
M. I). 119 Boylston Street, Boston, Mass. 
Yours fraternally, 
(Signed) .Tames Krauss, M. D., 
Chairman Committee American Association 

< 'I i /ileal Research. 
llii Boylston Street, Boston. 
August 18, 1909. 



MEDICINE IX GENEVA AND THE CAL- 
VIN FETES. 
To the Editor of the Hospital Bulletin: 

Called upon to represent the University of 
Maryland on the occasion of the University 
Jubilee at Geneva, Switzerland, I found myself 
eaily in July comfortably established at the Na- 
tional Hotel, a hostelry charmingly situated on 
the margin of the Lake of Geneva. Arriving 
somewhat ahead of time, owing to misleading ac- 
counts in the Swiss papers as to the order of 
events, I was ahle to see a little of two other 
fetes which took place about the same time, the 
Commemoration of the Foundation of the Geneva 
Protestant Church, and the laying of the corner- 
stone of the Monument to the Reformers, and the 
350th anniversary of the founding of the Academy 
or College by John Calvin and Theodore de 
Beye, which latter took place on June 5, 1559. 
Strictly speaking, Geneva cannot lay claim to 
being a very old University. Recent writers put 



the date at 1875 or 1876, so that it does not 
compare in age with many of our American uni- 
versities, nor can it he mentioned in the same 
breath with those of Bologna, Paris and Oxford, 
which are certainly 800 years old. Neverthe- 
less there is no doubt that the "Academies" 
founded in 1559 by Calvin, became eventually 
the University of Geneva, and (hat in those re- 
mote times Calvin was lecturing to more than a 
thousand students, among his pupils being John 
Strong, the Scottish Reformer; Thomas Bodley, 
the founder of the Bodleian Library at Oxford, 
and dean Jacques Rousseau, whose writings, 
more than any others, inspired the French Revo- 
lution. Nor can there he any doubt that during 
the comparatively few years of Calvin's life in 
Geneva he exercised an influence on general edu- 
cation on the Christian Religion, anil on the po- 
litical life of the State, thai many have been dis- 
posed to underestimate. Calvin and de Beye, 
the first Restorers of the Academy, were, in 
many respects, the most remarkable men of their 
time. Calvin was never a popular man in the 
sense in which we use the word : other Reformers 
were certainly of far more lovable disposition, 
hut he had remarkable endowments, and pos- 
sessed great strength of character. Of a clear 
and logical mind, he had the power of expressing 
himself, both as a writer and speaker, and a 
style of composition that has seldom been squalled. 
He was also a horn teacher, having not only the 
ability to attract large audiences, hut to retain 
their attention and interest. In de Beye or Beya, 
as he is perhaps more often called, Calvin had 
a coadjutant, committed to his view, both will- 
ing and ahle to carry out the details of instruc- 
tion under orders from his chief. The martyrdom 
of Michael Servetus, the distinguished physi- 
cian and anatomist, must he judged in the light 
of Calvin's character and the spirit of those 
times when discoveries in medicine were viewed 
with alarm. After all. as a man said to me 
when discussing the question, "the other fellows 
(meaning the Catholics) would have burned him 
if they had the chance." Death at the stake was 
to the popular mind a proper punishment for 
the man who held such heterodox opinions. 

A fact that interests us Americans, especially 
where new universities are springing up, or are 
made by associations of heterogeneous elements, 
that lose much of their efficiency through lack 
of co-ordination, is that Calvin and De Beye had 



134 



THE HOSPITAL BULLETIN 



from the first, even in their earlier times, when 
the Academy was started, the idea of what a 
University should he. Though they hail neither 
the qualified teachers or the funds to carry out 
their ideas, they laid the cornerstone for the I'ni- 
versity of Geneva on a solid foundation. Their 
personal qualities were their capital, for they 
had neither laboratories, museums, or elaborate 
physical appliances. To them is due the in! in- 
duction of class studies into general education. 
Dividing the students into groups, according to 
their ability to assimilate, lather than accord- 
ing to age, led to the "promotions" which exist 
under the same name today in the University of 
Geneva. "Promotions" according to the Swiss 
idea is the advancement of students from a lower 
to a higher class, after passing test examinations. 
Previous to this introduction of graded courses, 
students were taught in a mass, without regard 
to age or qualifications. 

In 1533 Calvin had been the central figure 
of the Reformation in France, his native coun- 
try. He was then ".' f years of age. Three years 
later — in 1536 — he published his "Institutes of 
the Christian Religion." In 153? he settled in 
Geneva and lived there until his death in 1564, 
at the comparatively early age of 55. During 
most of his life he was a great sufferer, his chief 
ailments being consumption and stone in the 
bladder. 

Fiske had called him the Father of Coligny, 
William the Silent and Oliver Cromwell. And 
this judgment of him seems to have influenced 
the committee which had in hand the planning 
of the Reformer's Monument, the cornerstone of 
which was laid opposite the University, with much 
ceremony, on duly (i. This monument, when com- 
pleted, will represent in colossal size Farel the 
Reformer, Calvin, De Beye and John Strong, while 
thinking them on either side will lie smaller figures 
of Oliver Cromwell, William the Silent, Frederick 
William of Brandenburg and our American 
linger Williams. 

It was noticeable that in all three celebrations 
Calvin was the central figure. The people both 
of city and State appeared to have forgotten his 
seeming intolerance and tyranny, or felt that they 
hail been sufficiently expiated by the monument 
they had recently erected to the great Servetus, 
and it was none the less a little surprising to 
the foreign delegate to hear Calvin lauded by 
Protestants and Catholics alike. Deucher, the 



venerable President of the Swiss Republic and a 
Catholic, in an eloquent address at the dinner 
given by the University, spoke of Calvin as the 
man who taught citizens to he conscientious and 
moral, and on the same occasion other Stale offi- 
cials, also Catholics, credited him with an in- 
fluence lor good which they hoped might live. 
To the modern Swiss Calvin is the Washington, 
to whom they owe their present democratic form 
of government. 

The University of Geneva came early into 
prominence through the number and ability of 
its theologians, later through it> departments of 
Law. Philosophy and Literature. The School of 
Medicine is of comparatively recent creation, 
though among its professors have been Carl 
Vogt and Edward Clapareda, comparative anato- 
mists; Harmon Fol, the embryologist, and Sigis- 
inund Laskowski, the anatomist. Its present 
teachers of practical medicine and surgery are 
unknown to us. hut, alter all, Geneva is a city 
whose population in 1907 was not more than 
1 'in, lino. This is. perhaps, the reason the United 
States had among its 29 delegates only two medi- 
cal men. Dr. W. II. Welsh, representing the Car- 
negie [nstitution, and myself. Most of the dele- 
gates were theologians of various sects. Perhaps 
the most interesting and noteworthy ceremony 
was held in the old St. Peter's Cathedral on July 
8, when delegates representing 24 countries, and 
•-''.'ii universities, learned societies or associa- 
tions presented their addresses before an audi- 
ence that filled the building to overflowing. 
Dressed, the greater number in their academic 
gowns, or robes, representative of an office or so- 
ciety, the brilliant display of color made a mosl 
effective picture against the sombre background 
of the grey old Cathedral. Each delegate, as 
he was called, advanced to the rostrum, addressed 
a few complimentary words to the audience, and 
handing his written address to the Rector, shook 
hands with him. and then retired to stand again 
with his delegation until each of its number had 
been heard from, when they returned to their 
seats and gave place to the next delegation. 

flench being the official language of the Uni- 
versity, most of the delegates spoke in that lan- 
guage. Occasionally German was used, and one 
delegate spoke in Latin. 

Baltimore and Washington were the only cities 
of our States represented by medical delegates. 
Other representatives of our huge cities were a 



THE HOSPITAL BULLETIN 



135 



number of Presidents of Colleges and Seminaries, 
and men of note generally. The complimentary 

deg s of Doctors of Medicine, cansea honoraris, 

were 33 in number, one only coming to the United 
States. It was conferred upon Loeb, of Cali- 
fornia, presumably for his work in physiology. 
Among those honored were M. Cewire, of Paris. 
for his discoveries of radia, active substances, 
and his work on radium; Dejerine, of Paris, for 
his work on the anatomical changes in diseases 
of the nervous system; Dufour, the celebrated 
oculist of Lausanne and Carre of St Gall, for 
his works on the bacteriology of tuberculosis af- 
fections; Van Gebuchten, of Lourain, Belguim, 
for Ins researches on the anatomy "I* the central 
nervous system; Golgi, of Paris, for his researches 
on the structure of nerve cells; Lister, for his 
antiseptic methods; Pawlof, of St. Petershurg, 
for his discove to the functions of the 

stomach; Sahli, of Berne, for Lis noti s on Inter- 
nal .Medicine; Waller, of England, for his studies 
on the physiology of bees. Among others hon- 
order were Guyot, the French surgeon; Haeckel, 
of Jena, the comparative anatomist: Kollmann, 
the embryologist, of Bales; Kronecker, the physi- 
ologist, of lie! ne; Recklinghausen, the bacteria 
pathologist, of Strassberg, and Ketzius, the his- 
tologist, of Stockholm. Original work, especially 
in anatomy or physiology, seemed to be regarded 
as the most worthy of honor. 

Delegates and noted guests to the ciumbeT of 
over 400 were entertained by the University, city 
and State, acting jointly. The fetes as a whole 
began on duly 26 and continued without inter- 
ruption until the nighf of the loth, when a grand 
"Commers" by the students brought the festivi- 
ties to a close in a blaze of glory. Nothwith- 
Btanding most unpropitious weather during the 
Jubilees, the final verdict will he. I am sine. 
that the fetes were a success. The elaborate 
entertainments that were provided day after day 
and the generous hospitality of our hosts will 
he long and pleasantly remembered, both by dele- 
gates and truest-. 

Thomas G. Satterthwaite, M. D., LL. I).. 
; Hast 80th street New York City. 



ii of John W. ami Sarah J. Ridgely Wilson. His 
earlier education was obtained in the public schools 
of Baltimore and Milton Academy, his medical in 
the University of Maryland, whence he graduated 
with the class of 1880. Since graduation his time 
has been devoted to the general practice id' medi- 
cine. He is medical examiner for The Shield of 
Honor Life Insurance and is a member of the 
Flint Cluh. He is a .Mason. He married Annie 
R. Mereier, by whom he has a daughter, Mareese 
Wilson. 



ITEMS. 
Doctor Lot Ridgely Wilson, class of 1880, is a 
native id' Baltimore, in which city he ha- engaged 
in the practice of medicine for more than twenty- 
five years. He was horn June 9, 1858, and is the 



Doctor Horace Melville Simmons, class of 1881, 
of Baltimore, was born in West Bedford, Coshoc- 
ton county. Ohio, June 30, 1854. He was the 
thinl son in a family of six children. His father 
a physician, emigrated from Maryland in early 
boyhood, and at the age of twenty-seven entered 
upon the practice id' medicine in Ohio. 

Doctor Horace Simmons received his early edu- 
cation in Deersville, Harrison county. Ohio. Later 
he entered the office of the "Cadiz Republican." 
After three years of practical experience in editing 
ami publishing, he accepted an engagement with 
the ••Coshocton Democrat." He matriculated in 
the Medical Department of the University of Mary- 
land in 1879, and received the degree of Doctor of 
Medicine in 1881. After graduating he returned 
to Ohio to enter into copartnership with his father. 
in which connection he continued until 1882, when 
he returned to Baltimore to enter practice. In 
1883 he married Miss Y. Estelle Dunning, 
daughter of the late Reverend Halsey Dunning, a 
Presbyterian clergyman of Baltimore. One son 
survives this marriage, Halsey Melville Simmons. 
M is. Simmons died in 1 895. 

Doctor Simmons was again married in 1903 to 
Miss Caroline Frazier Johnson, of Baltimore, and 
lesides at 1706 Park avenue, Baltimore. 

In 1893 he organized the Health Magazine Com- 
pany, of Baltimore ami Washington, to publish 
the •"Popular Health Magazine." The year follow- 
ing this company acquired the ownership of the 
''Maryland Medical Journal," and both publica- 
tions continued under his management until 1898, 
when the ••Health Magazine" was disposed of to 
a New York company. In July. 1906, Dr. Sim- 
mons acquired a controlling tnteresl in the "Medi- 
cal Review of Reviews," int.. Yew York and Lon- 
don. In 1909, he relinguished the management 
of the "Maryland Medical Journal" to Dr. Nathan 
Winslow, class of 1901, so that he might he able 
to devote his entire energies to the "Review." 



136 



THE HOSPITAL BULLETIN 



Doctor John S. Fulton, class of 1881, professor 
of State medicine in the University of Maryland, 
was born in 1859, at Fremont, Ohio. Be is the 
oldest son of Reverend William Fulton, 1). 1).. of 
Glasgow, Scotland, and his wife, Nancy Organ, of 
Cable, Ohio. He came to Maryland in 1863, when 
his father became rector of All Hallows' Parish, 
Snow Hill. He removed to Salisbury, Mil., in 
1869. In 1872 he entered St. John's College, An- 
napolis. JIil., graduating in 1876, then entered the 
office of Dr. Stephen P. Dennis, Salisbury, as a 
student of medicine and taught in the public 
schools for two years. He then entered the medi- 
cal department of the University of Maryland, 
wheic he was graduated in 1881. From 1881 to 
1881 he practiced at Lakeville, Dorchester county, 
Md., and in Salisbury, 1881 to 1895. In the lat- 
ter year he moved to Baltimore ami became chief 
of clinics in internal medicine at the University 
Hospital Dispensary and later clinical professor of 
Medicine. In November, 1896, lie was made sec- 
retary of the State Hoard of Health of Mary- 
land, and in 1902 was appointed professor of 
State Medicine in the University of Maryland. 
About 1906 he resigned the secretaryship to the 
State Board of Health to become secretary of the 
International Congress on Tuberculosis, in which 
position lie displayed marked executive ability and 
generalship. Doctor Fulton married in 1888, 
Nancy Helen White, of Salisbury, Md. 



Dr. John Homer Hoffman was born in Balti- 
more, Augusl 17, 1857. He is a son of Dr. Dan- 
iel P. and Maria Burot Hilhert Hoffman. His 
literary education was obtained at Loyola College, 
Baltimore, and his professional in the medical de- 
partment of the University of Maryland, whence 
he was graduated with the class of 1881. Since 
which time he has been engaged in active practice 
in his native city. Doctor Hoffman is a member 
of the Roman Catholic Church, the Crescent Club 
and at one time was a member of the Baltimore 
Clinical Society. In September, 1SS:i. he married 
Miss Susie L. Burke, by which union he has be- 
gotten four children — May I.. Reginald K., Alma 
L. and Joseph D. Hoffman 



Doctor Caleb \. Athey, class of 1894, of Bal- 
timore, was married to Miss Helen Skipwith Wil 
mer, a graduate of the Johns Hopkins Training 
School for Nurses, August 3, 1909. 



Doctor Walter Van S. Levy, class of 1904, for- 
merly of Baltimore, but now of Stonleigh Court, 
Washington. District id' Columbia, has applied to 
the Circuit Court Xo. 2 to have his surname 
changed to Van Swearingen, a family name. The 
petition states Dr. Levy is a Gentile; is he, ami 
the name signifies a person of Jewish extraction. 
An oi del' signed by Judge Heuisler requires cause 
to he shown by October I. 1909, why the petition 
should not he granted. 



Doctor Edward A. Wareham, id' Hagerstown, 

.Md.. made a short address upon "Clip," at the 
Seventh Annual Convention of the Cumberland 
Valley .Medical Association. Doctor J. Walker 
Humrichouse, class of 1873, was one of the com- 
mittee on arrangements. Doctor Michael J. Me- 
Kinnon. a venerable physician, of York, Pa.. i< 
se; iously ill at his home. 



Doctor Alberto L. Bartlett lias the honor of 
announcing that he has been nominated the local 
head id' the National Sanitary Board. Doctor 
Bartlett is located at Placetas, Cuba. 



Doctor and Mrs. T. B. Maiden are making an 
extensive trip through the AYest. 



Doctor Siimmerlield B. Bond was recently elect- 
ed vice-president of the Baltimore and Ohio As- 
sociation of Railway Surgeons. 



Doctor Somerset R. Waters, of Ml. Airy. Md.. 
is a candidate for the House of Delegates Erom 

Carroll county upon the Democratic ticket. 



Dr. Joshua W. Hering. who was re-nominated 
for Comptroller of the State Treasury, was proba- 
bly the oldest man of prominence at the recent 
Maryland State Democratic convention. He was 
born in Frederick county 76 years ago. Great as 
has been the demand upon his time as a physician, 
regardless of the hour of day or night, he has 
found time to take active part in religion, educa- 
tion, finance and politics. In every field he has 
gained distinction and honors. 

After si inlying in the public schools of his native 
county, he. as a boy. started to work in a store, but 
decided that he would rather be a physician, lie 
began the study of medicine under the private 
tutorship of Dr. William A. Mathias. at that time 
a vjrominent practitioner in Westminster. He then 



THE HOSPITAL BULLETIN 



137 



came to Baltimore and took the course at the Mary- 
land University, getting his degree in medicine in 
1855. Returning to Westminster he soon built up 
a lucrative practice and prospered in the business 
enteiprises in which he became interested. In 186 1 ! 
he was chosen cashier of the Union National Bank 
of Westminster. IIi~ prominence among the bank- 
ers of the Slate, aside from his other interests, was 
such that in 1899 he was elected president of the 
Maryland Bankers' Association. 

A devout churchman, he was given one honor 
after another by the Maryland and general con- 
ferences of the Methodist Protestant Church. In 
1892 he was elected president of the General Con- 
ference, the only layman who ever held that posi- 
tion. Dr. Bering has always been intensely in- 
terested in the welfare of Western Maryland Col- 
lege, at Westminster, which is connected with his 
church. He is the president of the board of trus- 
tees and the only living charter member of thai 
board. He was given the degree of master of arts 
by Western Maryland College in 1885 and the 
degree of doctor of laws by St. John's College in 
1900. 

Although always a stanch Democrat and one of 
the most popular men in the party in the State, it 
was not until 1896 that he accepted office. In that 
year he was elected to the State Senate. He was 
first elected Comptroller of the State Treasury in 
1899. In 1901 he was re-elected, but declined the 
nomination, lie was re-elected in 1907, and now 
he has been re-nominated to serve a fourth term 
in that office. 



Hi-. William .1. Todd read an interesting paper 
at the recent meeting of the Baltimore County 
Medical Association, held at Towson, on the life 
of the late Dr. Josiah S. Bowen, the pioneer physi- 
cian id' Mount Washington, who did much toward 
the development of that place. Dr. Bowen was 
horn on March 1. is:!'.', on the Hillen road. In 
early life he was a general contractor, and in 1854 
he went to California and shared the hardships 
and adventures of the "old seekers there. 

In 1860 Dr. Bowen returned to Maryland. In 
1865 he graduated at the medical department of 
the University of Maryland. The same year he 
located at Mount Washington, and became one of 
its leading citizens. In conclusion Dr. Todd said: 

"It can he said of Dr. Bowen that his life was 
quiet, industrious and unassuming, and that it was 
a success, because in his long ami active practice he 



relieved the sufferings of the sick and added com- 
I'oit to the poor and the aTicted. I recall the 
-luck to me and the community of his sudden 
death, being found dead in his chair on the morn- 
ing of August ""», 1900, after arranging for the 
business of the day — actually dying in the har- 
ness." 

Dr. Josiah S. Bowen. class of 1903, of Mount 
Washington, is a son id' Dr. Bowen. 

Dr. Benjamin F. Bussey, class of 1885, president 
of the Association, presided at the meeting. 



Doctor James A. Shackelford, class of 1876, of 
Greenville, Mississippi, died at the home of his 
nephew in Carrollton, Mississippi, duly in, 1909. 



Reverend Edward Mortimer Hardcastle, class id' 
1889, of the University of Maryland, died at his 
home in Kaston, August 15, 1909, of consump- 
tion, aged 42. 



Doctor Byron Clark, class of 1881, formerly 
professor of theory and practice of medicine in 
the Eclectic Medical College of the City of New 
York, died at his home in Washington, Pennsyl- 
vania, August 5, 1909, from diabetes, aged 72. 

Doctor Marshall B. West, clas^ of 1901, has 
bought of Elias Livezy a residence and two-acre 
lol mi the east side of lngleside avenue. Catons- 
ville. 

Doctor d. Frank Crouch has purchased from 
Pierre C. Dugan and Nephew, real estate brokers, 
representing Thomas O'Neill, a parcel of seven- 
teen acres from the large tract of land recently 
purchased by Mr. O'Xeill on the Severn river. The 
land is beautifully situated at the junction of Cold 
Spring Creek and the Severn river and is known 
as Long Point. It is the intention of Dr. Crouch 
to improve the land and erect a beautiful sum- 
mer residence, for which he is having plans pre- 
pared. 



Doctor Taylor E. Darby, class of 1904,of Barnes- 
Mile. Maryland, was one of the successful candi- 
dates before the last examination of the Army 
.Medical Examining Board, for a commission of 
second lieutenant in the Medical Corps of the 
United States Army. He will be stationed at 
the Army Medical School, Washington, for a year 
when he will take the examination for a first 
lieutenancy. 



138 



THE HOSPITAL BULLETIN 



"Dr. Arthur E. Ewens, who was elected Su- 
preme Medical Director at the recent session of 
The Supreme Ruling, is. in the language of 
Brother H K. Eaton, who nominated him for 
this important office, 'of sterling qualities and 
unimpeachable integrity, occupying a pre-eminent 
position both as a man and as a physician.' 

■'The history of the University of Maryland, 
Vol. 3, p. 477, gives much interesting information 
in regard to his achievements and his high stand- 
ing in his profession. He is a graduate of the 
State College of Maryland (his native State). 
at which College lie received the degree of Bach- 
elor of Science and was awarded the gold medal 
for the best graduation thesis. Upon the com- 
pletion of his college course he entered the Medcial 
Department of the University of Maryland, from 
which institution lie graduated with honor in a 
class of 150, receiving the degree of Doctor of 
Medicine. Immediately following his graduation 
he took a competitive examination for appoint- 
ment as resident physician and surgeon to the At- 
lantic City (X. J.) Hospital, receiving first place 
and serving in the above position for one year. 
He enjoys the distinction of having received one 
of the highest averages ever made before the New 
Jersey State Board of Medical Examiners, winch 
is universally recognized as maintaining a very 
high standard. At the time he took this exam- 
ination 72 physicians came before the Board for 
examination, and the Doctor was one of only two 
physicians who attained an average of over 90 per 
cent. In recognition of this remarkable record, 
his name was sent to the Governor of New Jersey 
in receive honorable mention. 

"At the expiration of his first four years in the 
practice of medicine he was chosen out of 150 
Atlantic City physicians for the high and respon- 
sible position of Surgeon to the Atlantic City Hos- 
pital, his election being unanimous. For some 
time he held the position of Medical Inspector of 
Public Schools in Atlantic City. He is also Vis- 
iting Physician and Surgeon to the Foster Home 
for Orphans at Longport, X. J. 

"Dr. Ewens is a member of the following Med- 
ical Societies: The Atlantic County Medical So- 
ciety; Medical Society of the State of New Jer- 
sey; American Medical Association; Atlantic City 
Academy of Medicine, and the American Academy 
of Medicine and Medical Club of Philadelphia. 

"That he is a true Fraternalist is conclusively 
indicated from the fact that he is a member of 



the Fraternal Mystic Circle: Ancient Order of 
United Workmen; Modern Woodmen of America: 
Brotherhood of the Union; Patriotic Order of the 
Sons of America : Bata Mu Chapter of Phi Gamma 
Delta Fraternity at the Johns Hopkins Univer- 
sity (where the Doctor took a post-graduate 
course), ami he is also a member of Belcher Lodge. 
Xo. 180, of Free and Accepted Masons, Atlantic 
City, X. J. 

"As Worthy Medical Examiner for the Fra- 
ternal Mystic Circle his is a most remarkable rec- 
ord. While he has examined between 300 ami 400 
applicants during the past three years, so carefully, 
skillfully and conscientiously has his work been 
conducted that up to the present time there has 
not been a single death. He is a member of Pro- 
gressive Ruling, Xo. 890, at Atlantic City. X. J., 
in connection with which Ruling this splendid rec- 
ord was achieved. 

"Dr. Ewens has entered actively and earnestly 
upon the duties of his office, and it can safely he 
predicted that he will achieve the same satisfac- 
tory results in this responsible position which he 
has in every other one he has ever occupied." 



The State Board of Medical Examiners of North 

Carolina, which met at Asheville June 9, 1909, 
announce that Doctor Branch Craig, class of 1909, 
of Salishuiy. North Carolina, attained the highest 
grade. 95 6-7 per cent. Those of our school ap- 
pearing before the Board successfully are: 
1 loctors — 

Robert W. Crawford, class of 1906, of Rocky 
Mount. 

G. D. Moose, class of 1907, of Wilson. 

1). C. Absher, class of 1909, of ohids. 

Asa Thurston, class of 1909, of Taylorsville. 

James L. Moorefield, class of 1909, of Guilford 
College. 

Robert S. McElwee, class of 1909, of Statesville. 

C. L. Swindell, class of 1909, of Kinston. 

Edgar M. Long, class of 1909, of Hamilton. 

J. F. Dowdy, class of 1909, of Winston-Salem. 

J. D. Weatherly. class of 1909, of Kernersville. 

Fred. Wharton Rankin, class of 1909. of Moore- 
ville. 

Branch Craig. cla>s of 1909, of Salisbury. 



We are pleased to announce that all candidates 
from University id' Maryland of the class id' 1909 

appearing before the North Carolina State Board 
of Medical Examiners did the school the honor of 



TIIK HOSPITAL BULLETIN 



139 



receiving their licensure. Indeed, out of thirteen 
appearing before the Board only one of class of 
l!in | failed to receive his license. 



Doctor John S. McKee, class of 1907, of Ra- 
leigh, North Carolina, is taking the Post-Grad- 
uate Course a1 the University of Maryland, 



Doctor Thomas Eben Peeks, class of 1901, of 
New Britain, Connecticut, who recently had a 
gastro-enterostomy made on him by the Mayo 
Brothers, has been spending a few days in Balti- 
more. He is looking hale and hearty and does 
nol look the invalid. 



I inetov Henry McKee Tucker, class of 1899, of 
Raleigh, North Carolina, stopped off recently on 
his way to New York, to take a Post-Graduate 
course. He reports that he has succeeded in build- 
ing up a nice practice. This will he good news 
to Dr. Tucker's numerous friends. 



Doctor James Lee .Hopkins, class of 1897, of 
Havre de Grace, Maryland, paid a hurried visit 
to the University Hospital recently. He is look- 
ing hale and hearty. 



Doctor Walter Van S. Levy, class of 1904, of 
Baltimore, has been appointed visiting patholo- 
gists to Freedman's Hospital, Washington, as a 
result of a competitive Civil Service examination. 
It is reported that he was the only eligible out of 
lil'tv candidates. 



Doctor C. E. Kriete, of Aberdeen. Maryland, 
has been appointed an official of I lie Harford 
( lounty Marathon. 



Doctor James M. Craighill, Clinical Professor 
of Medicine, has returned from Canada. 



Doctor William E. Martin, a prominent mem- 
ber of the class of 1909, of Harrisonville, Md,. 
has issued an announcement that he was married 
to Miss Hannah Bailey, of Easton, Md., Sep- 
tember 25, 1907. Dr. Martin, who is the son 
of Mr. and Mrs. William Martin, of Sykesville, 
Md., met Miss Bailey in 1904, while she was study- 
ing to lie a trained nurse in the Springfield Hos- 



pital. They were married at Chambersburg by 
the Reverend Doctor Glenn, pastor of the Meth- 
odist Episcopal Church there. Doctor and Mis. 
Martin will make their home at Harrisonville, 
where the Doctor will engage in the practice of 
his profession. 



DEATHS. 
Doctor James Bordley, class of 18(>8, one of 
Queen Anne's county's most prominent physicians, 
died at his home, in Centreville, on the afternoon 
of August 30, 1909, after a. lingering illness. 
Doctor Bordley was horn in Centreville, March 14, 
1846, and was taken by his parents in 181!i to 
Baltimore, where he remained until 1861. He then 
entered St. John's College, now the department of 
Aits and Sciences of the University of Maryland, 
Lint when the war began he commenced the slud\ 
of medicine at the University of Maryland. After 
his graduation in 1868 he opened an office in 
Centreville, where he has since successfully en- 
gaged in practice. He was elected the second presi- 
dent of the Maryland State Board of Medical Ex- 
aminers, serving from 1893 until his resignation 
in 1896. He was at one time president of the 
Queen Anne's County Medical Society. For years 
he was a director of Centreville National Bank. 
At the time of his death he was president of the 
Building and Loan Association of Queen Anne's 
County. 

In 18(18 Doctor Bordley married Miss Henrietta 
M. C'hamberlainc, of Cecil county, who died within 
a year. In 1871 he married as his second wife, 
Miss Ella F. Brown. By this union was begotten 
three children — Madison Brown, who is a grad- 
uate of the University of Maryland and now clerk 
to the County Commissioners for Queen Anne's 
county; Doctor James Bordley, Jr., who is a grad- 
uate of the Medical Department of the University 
of Maryland, class of 1896, and an ex-resident of 
May View Asylum, and Meicello Worthington, who 
is a graduate of SI. John's College. 

In connection with his professional and other 
duties. Doctor Bordley superintended the operation 
of his farms in Queen Anne's county. He was 
counted one of the most successful and energetic 
business men as well as one of the leading physi- 
cians of the Eastern Shore of Maryland. He was 
a prominent member of many societies and was 
their medical examiner. In politics he was a stanch 
Democrat. 



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THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 
PRICE ftl.OO PER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. V 



BALTIMORE, MD., OCTOBER 15, 1909. 



No. 8 



A SERMON TO STUDENTS AT THE BE 
GINNING OF THE SCHOOL YEAR. 



By Rev. Jesse Hill, 



Pastor of the IVilliston Congregational Church. 
Portland, Maine. 

Learn to do well. — Isaiah 1:17. 

The Biblical writers are always in their glory 
when they are delineating- the growth of human 
character. The different stages of character un- 
folding was one of their chief delights, and they 
are never more charming than when picturing the 
progress of a man from his lesser to his greater 
self. They were lovers of a well-balanced man- 
hood. In all their figures of speech and descrip- 
tions they represent life as a great effort. Life 
is a struggle. The discipline, the toil and drudgery 
are represented as having a very beneficent in- 
fluence in the development of character. Dr. 
Drummond declares that the great allies of prog- 
ress are want and hunger ; that the inertia of 
things is such that without compulsion they will 
never move. He compares the evolution of a man 
to the experience of a little bird in a city park, 
whose day is spent in getting a living. It awak- 
ens at daybreak and sets out to get its breakfast, 
but another bird has been awake before it, and it 
has lost its chance. With 30 other breakfastless 
birds he must bide his time, scour the country, 
prospect the streets, the grass, the ground. At 
every meal the same program is gone through, and 
every day. As the season changes the drudgery 
becomes more keen. Its supplies are exhausted, 
and it is compelled to take its wing and emigrate 
to a new country. This is how birds live, and this 
is how birds are made. Life is a fierce effort, a 
supreme struggle — beek and limb, claw and wing, 
shape, strength — all down to the last detail are 
the expressions of their mode of life. 

Human life is also a struggle, excepting that 
man is sometimes lured on bv visions of glorv in- 



stead of being goaded on by hunger. There is a 
prevalent conception in the world that there are 
some favored positions and vocations, where suc- 
cess is attained without the treadmill. But it is 
probably true that there is just as much prosaic 
uninviting detail forced into the lives of those who 
are supposed to be living the charmed life as there 
is in your life. 

Not manypeoplewho stand before a great paint- 
ing and admire the genius, skill and brain of the 
artist ever appreciate the years of privation and 
poverty that lay back of the artist's success. 
Everything valuable is costly. The dimensions of 
our soul life are determined by the ideal to which 
they are set. The quantity and quality of person- 
ality depend upon the scale after which we copy. 
If the ideal be complete, the life will be rich and 
full, and if the dominating aim of our life be un- 
steady, without a clear-cut purpose and definite 
goal, the life will be as shapeless as a jellyfish. 

The growth of every character has three stages 
— past, present and future. The past is the field 
of wisdom; the present the sphere of endeavor; 
the future the home of hope. 

It is possible to live in the past and speak words 
of wisdom, but to miss the everlasting joy of 
transforming present realities into living facts. 
It is possible to live in the present and forget the 
storage of wisdom which men have left for our 
encouragement. And the life whose eyes are fas- 
tened only on the future, while hands hang list- 
lessly at one's side, may stand sometimes upon the 
transfiguration mount, but he has left the animals 
at the base of the mountain in whose presence 
there is little safety of those for whom we are re- 
sponsible. No man can be content with the past 
or present. We are continually stringing our 
harps for the winds of tomorrow. Today is the 
child of yesterday, and tomorrow is the legacy of 
today. All future character depends upon our 
use of the present. 

Someone asked, "Where was Italy three cen- 
turies ago?" and the answer was. "Under the cap 
of Dante." For, in the dream of the patriotic 



142 



THE HOSPITAL BULLETIN 



poet, there throbbed the picture of broken and 
bleeding Italy, marching forth in triumph to its 
present progress — liberty and union. 

Protestantism three centuries ago was under the 
cowl of a Wittenberg monk, but his brain was the 
soil in which grew the seed which we call Zwingli, 
Melancthon, Knox and Wesley. 

Where was education three centuries ago but in 
the brain of Comenius, and his life was the soil in 
which Rosseau, Froebel and Pestalozzi sprouted. 
And the education of tomorrow is all about us, in 
the lives of those whom too often we fail to ap- 
preciate. 

Once a year, just after the great throng of 
young people have heard again the call of the col- 
lege or the high school, and before they cross its 
threshold, I like to devote one service to the con- 
sideration of some phases which may be sug- 
gestive to them in the new field of effort to which 
they are called. 

There are four words around which there gath- 
ers wisdow for those who have ears to hear. These 
words are cultivate, accumulate, habitate and ded- 
icate. 

The first of these words is CULTIVATE. 

We are the offspring of cultivation. Natural- 
ists have often pointed out to us the fact that 
while man is a ruler among the animals, he is also 
the most helpless creature at birth, and requires 
the greatest cultivation to reach anything like 
maturity. The chick begins to peck as soon as it 
leaves the shell ; the duckling takes to water at 
once ; birds fly in a few weeks after they are 
hatched, while in three months a pup can execute 
untold damage on his mistress' parlor carpet, but 
the babe's life hangs by a thread for many davs, 
and infinite care is needed, in the absence of fav- 
orable conditions its life is in danger, and with 
favorable conditions many months must pass be- 
fore the child can even stumble around. The 
family, the church, the State and the school then 
begin to contribute to its education. 

The force of this command to cultivate our life 
gains very much emphasis when we remember 
that upon the use of our present there is an 
inevitableness in the result. When Charles Dick- 
ens first published the "Old Curiosity Shop" he 
was flooded with letters from all parts of England, 
from people who had read the story in install- 
ments in the magazines, pleading with him not 
to take the life of Little Nell. But be yielded to 
the inevitable, and when at last he reached the 



story of her health, all night he walked the streets 
of London, sad at heart, as though he had lost a 
real friend, but he said : "I had to do it ; the pre- 
ceding events demanded it," and upon the use of 
your present opportunity some of you will write 
a silly novel; some will write a fearful tragedy, 
and some a psalm full of sweetness and love for 
all mankind. 

The Divine command to every individual is to 
cultivate his field. We are to make the most of 
ourselves and the place that God has given us. 

History has given us few better ilustrations of 
the art of cultivation than the story of Michel 
Angelo. Old, blind, feeble, feeling his way into 
the art gallery, and with uplifted face, putting his 
fingers and hands over the torso of Phidias, the 
Cardinal heard him say : "Great is this marble, 
greater still the hand that carved it, greatest of 
all the God who fashioned the sculptor ; I still 
learn, I still learn." 

Think of the man who is willing to toil in the 
drudgery of painting the ceiling of the Sistine 
Chapel with the picture of his "Last Judgement" 
and the story of the "Creation" for seven years, 
until the muscles and cords of his neck had be- 
come so rigid that he could not look down without 
bending his whole body. Think of the man who 
carried his bread with him to the scaffold and 
worked while he ate, so that he might not lose any 
time. For days his clothes remained on his body, 
and his eyes refused sleep. By the side of his bed 
he kept a block of marble, and the chisel and mallet 
lay on his table, and the call of a new idea was 
never disobeyed. When his three score years and 
ten were passed he still said, "I still learn, I still 
learn." Such a man could not help but immortal- 
ize himself in art. 

May I use another illustration? You have heard 
of the life of Robert Louis Stevenson. He was 
counted by some the most remarkable English 
writer of his generation, but the work of his pen 
was the smallest part of his life. If the stories 
he wrote and the poems with which he enriched 
the world are at last forgotten, what the man was 
will live, for his character was one of the most un- 
selfish and lovable in human being?. At 20 years 
of age he had spent most of his time trying to 
tinker up his physical frame, and then found him- 
self a nervous wreck ; at 30 years of age, just able 
to sit up in bed and mould clay figures', after 
which he rapped his fingers upon the board and 
called for his writing: materials, and rave form 



THE HOSPITAL BULLETIN 



143 



to those remarkable stories that were the delight 
of our earlier life. Fighting his poverty, lowli- 
ness, ill-health, he rose above his troubles, and to 
the very last remained the child of laughter and 
sunshine. Men said of him that he was always 
eager to help his fellows, always ready to take the 
second place. With great difficulty offended, and 
expecting to die for 20 years, he "dug out the ker- 
nal of life and threw away the husks." Each 
morning seemed to him like a golden gift from 
God of which he must make the most. 

It ought to be the mission of your life to culti- 
vate facts. Concrete facts are terribly dynamic. 
Intelligent knowledge is the rudder of zeal. With- 
out facts men sail and sail, and arrive nowhere. 
A multitude of people have accumulated some- 
thing like facts — forty-second cousins to the real 
thing, but so often have failed to get the facts. 
See to it that you recognize the tremendous power 
of facts in your education, but remember that 
facts, after all, are but means to the end. The 
mission of the teacher and the school is to enable 
people to think. It is to draw inferences from 
certain facts, it is to arrive at certain conclusions. 
Cultivate not only the power of fact and think- 
ing, but also the power of expression. So often 
in human life we find that the most intelligent 
people must secure men to carry their intelligence 
to market. Now, the marks of a cultivated life 
are modesty, humility, delicacy of organization, 
and executive tact ; just the things that are usually 
crushed in the struggle for life, thus the real forces 
of life are often obscured. The great lawyer is 
not always at the head of the bar; the man who 
speaks twenty languages is not the successful 
teacher: Samuel Johnson was not skilled enough 
in literary bargains to protect his self-interest: 
the walking encyclopaedia is usually used as a ref- 
erence library. This is because men have not cul - 
tivated themselves symmetrically. See to it that 
while your brains are cultivated that your brawn 
is not forgotten. When you decline Latin, see 
that you do not decline exercise. Let the culti- 
vation of your life give you the fullest use of all 
your powers. It has been too long supposed that 
a man goes to school so that they may pump wis- 
dom enough into him to enable him to ladle out 
at retail all the remainder of his davs. provided he 
does not ladle too fast. Rut the most important 
part of education is what you get for yourself. 
The term education has been abused, but never- 
theless it stands fo*- a great idea. All that the 



school can do for you will be but a small matter 
compared with what you must do for vourself. 

The second duty in the struggle of life is to 
accumulate. 

I exhort you to amass a fortune in your field ; 
even on its lowest basis — that of money — it is the 
duty of a man to make his expenditure less than 
his income. The tendency in our age is toward 
extravagance. Debt has ruined a multitude of peo- 
ple. What is there that is more pathetic than that 
picture in the life of old Walter Scott, when Lock- 
hart wheeled him into the summer house and saw 
that he was killing himself by the work which he 
felt he must do because of his debts. One day he 
suddenly said : "This will never do, I must get 
down to work." and when he tried, he could not 
hold the pen or dictate a word, but sat still, with 
the tears streaming down his fine old face — a vic- 
tim of debt. 

Someone has said, If you should call the roll of 
a score of the most cultivated children of this gen- 
eration, you would find that eight out of twenty, in- 
cluding a great orator, a novelist, two jurors, a 
wit and two statesmen were all caught in the 
meshes of debt. These sons of genius fell on 
death, like birds caught in the thicket that tore off 
their bright plumage in the struggle to escape the 
thorns, only to fall, beating their bleeding wing> 
against the ground. There is a happy land be- 
tween the acrtic zone of poverty and the tropic 
zone of plenty where men spend less than they 
earn, and thus accumulate. But remember that 
money is not the only wealth. Anything that 
makes for weal is wealth. Mr. Pearson, who has 
given his millions for colleges, would be poor if 
he had nothing but his money. Mr. Peary, in the 
Arctic regions, with bones and metals would be 
richer than the Standard Oil magnate with his 
checkbook. Money is easily destroyed. A gold 
piece will wear away. The banknote will disap- 
pear at the touch of a match. Every man can ac- 
cumulate better goods than these. Knowledge is 
one of the things that does not perish. Health is 
a blessing that has no value in money. There 
is a certain atmosphere — an indefinable quality — 
sometimes called culture, that comes from a course 
in college that is invaluable in life. Think of the 
people that never accumulate. They had a single 
talent given them at the beginning and they 
wrapped it in a napkin. It was a small napkin. 
There the people who began small grow smaller 
and finally evaporate. They are like one of the 



144 



THE HOSPITAL BULLETIN 



rivulets that we meet in our summer travels, trick- 
ling, like a slender thread, their way among the 
barren stones, but every thirsty noondav sun 
makes them disappear. They trickle, trickle, 
trickle until death dries them up, and no one 
misses them. They were a blessing to no one ; 
they refreshed no living thing. Earth is not any 
poorer for losing them, and heaven not much 
richer for gaining them. How much different is 
the life that grows richer through accumulation. 
Their life is like a river. It has its birth under 
some mossy rock in the mountain. It steers its 
modest path over the rough roads, laughing, leap- 
ing with its own silvery music. Sometimes it dis- 
appears for a while, but when you find it again 
it is like a broad river, beating against its banks, 
swelling up and kissing the boughs that bend over 
it, and spreading out and spreading out until on 
its placid bosom the ships laden with merchandise 
ride at anchor, and in its azure depths is mirrored 
the flags of every nation. Let your life grow rich 
in the volume of every grace, and as you sail the 
great ocean of life see to it that you mirror back 
the glory of Christ's gracious handiwork, as you 
bear up human hopes and contribute your share 
to the enrichment of the world. 

The third step in the struggle of life is to have 
a goal of Habitation. Every man makes his own 
world. We may make out of the materials a 
mansion. Multitudes of people that have beautiful 
houses live in baskets, because they live subordi- 
nate to physicial pleasures and public wants. With 
everything about them, there are people who fail 
to use what they have in the right way. 

In a Western city a church was about to erect 
a building, and the question arose as to what ma- 
terial should be used. Some would have granite 
of New England ; others wanted the green rock 
of Pennsylvania, and some others were in favor 
of the limestone and brick. An old farmer said : 
Let us build our church out of the very bowlders 
which lie on the surface of the prairies all about 
us. The novelty of the suggestion brought every- 
body to its support. The church was built, and 
then it was discovered that from these homely 
stones an edifice of sumptuous beauty had been 
reared. In them were all the glories of the rain- 
bow, and this house, constructed at little cost and 
from material unnoticed, is the admiration of all 
who see it. Though each be unattractive in itself, 
yet grouped together in the tones of precious 



stones, the materials of a glorious life lie all 
around us. 

From the lumber that is taken from the same 
mill one man constructs a hovel, another builds 
a mansion. The only difference between the mor- 
tar and bricks that are used in the warehouse and 
the mortar and bricks that are used in a palace 
is the dream of the architect. The difficulties 
which hinder one man become stepping-stones to 
another man. Marsden says, "Some people, like 
the bee, seem to gather honey from every Mower ; 
while others, like .the spider, carry only poison 
away." One person finds happiness everywhere, 
and on every occasion carrying his own holiday 
with him ; another always appears to be returning 
from a funeral. One sees beauty and harmony 
wherever he looks ; his very tears afford him vi- 
sions of rainbows as the sunbeams of hope fall 
upon them. Another is blind to beauty ; the lens 
of his eyes seem to be smoked glass, draping the 
whole world in mourning. One sees in the match- 
less rose nothing but rose water for sore eyes ; 
another reads in its blending colors and its won- 
derful fragrance the "thoughts of God." 

One student finds just what he is looking for in 
the college to which he goes — the best teachers, 
the finest equipment, the most glorious history — 
and he becomes an enthusiastic alumnus at the end 
of his course ; but another finds in every college 
to which he goes that the equipment is limited, the 
teachers poor, and the college devoid of any true 
spirit. ( )ur subjective attitude has much to do 
in what the school will mean to us. 

The earth beneath our feet is largely composed 
of four substances : Clay, sand, soot and water. 
Give it the right conditions, and the clay will be- 
come porcelain and furnish the finest kind of a 
background for a fine painting; give the sand the 
right conditions, and it will become hard and 
white and will take into itself the blue rays of the 
sunlight and become a sapphire : the soot, under 
proper conditions, is transformed into a diamond, 
and the water in the summertime is a dew drop 
and in the winter a star. 

The humblest and lowliest life with the right 
spirit may build a mansion with a window that 
opens out on to the radiant clouds ; a mansion, 
with a door to the street that swings out, that the 
tenderness and sympathy of our lives may flow out 
to a saddened world, and swing in with a hospital- 
ity that may be found for the stranger, the desti- 



THE HOSPITAL BULLETIN 



145 



tute in the fireside and table of good cheer which 
we give to the world. 

And, finally, it is your duty toDedicate your life. 
In the 18th Chapter of Jeremiah there is a re- 
markable description of Jeremiah's one day go- 
ing into the valley where the potter was at work 
moulding clay on a wheel. And as he stood by 
and watched the skillful manipulation of the 
worker he had no idea what pattern was in the 
designer's mind, though probably it was one of the 
noblest conceptions and designed for some royal 
or special purpose. And so by those rapid revo- 
lutions of the wheel, the ideal began to take shape. 
Suddenly the designer took the clay from the 
wheel with an exclamation of disappointment. The 
design was spoiled. Because the teacher was 
wanting in skill ? Xo ; but because the clay refused 
to take on the shape which he had designed. The 
work was therefore marred on the wheel, and he 
was compelled to make out of the clay some in- 
ferior vessel to that which he had intended. It 
might have served a noble purpose in a royal 
household, or even in the temple service, but it was 
now fashioned into some coarser form, for use 
in a business house. 

The parable is not without its lesson, and so, if 
we dedicate our lives to Him completely, the ideal 
will reveal itself in our experience. It is a fatal 
mistake to put off the matter of sharing that with 
which we are intrusted until some future time. 
If you ever expect to bless the world, begin now. 
Whatever wisdom you have is a trust for the sake 
of ignorance ; all wealth is a trust for the sake of 
poverty. You are simply stewards of strength 
for the sake of those who are weak ; every college 
boy and girl, and, indeed, every high-school boy 
and girl is a privileged life. They are selected 
people in the providence of God, and to none more 
than these should there come a great conviction 
that it is to be their privilege and duty to build the 
booths in the desert of life for the sake of the 
world-smitten ones, and to dig the springs in the 
oasis for the sake of life's thirsty ones ; to bear 
the burdens of those whom they meet, and in that 
very dedication they shall build for themselves a 
palace of beauty which shall be filled with pros- 
perity and God's peace. 



Take a dish of water cold, 
A little leaven of prayer, 

A little bit of morning glow, 
Dissolved in the morning air. 



Add to your meals some merriment. 

A thought of kith and kin. 
And for your prime ingredient 

A plenty of work thrown in. 

Then spice it ail with an essence of love, 

And a little whiff of play; 
Let the wise old Book and a glance above 

Complete the well-made day. 

Cultivate — Accumulate — Habitate — and Dedi- 
cate your life in the struggle for existence. 



A VISIT TO THE MAYO CLINIC AT 
ROCHESTER, MINN. 



By Randolph Winslow. 

The city of Rochester is situated in Minnesota, 
350 miles northwest of Chicago. Its population 
is about 8000. It is the county-seat of Olmsted 
county, Minnesota, which is said to be the richest 
agricultural county in the United States. It is 
quite a handsome town, with attractive residences 
and large stores. Its chief importance, however, 
is due to the fact that here is located St. Mary's 
Hospital, at which the Drs. Mayo do their sur- 
gical work. St. Mary's Hospital is a fine institu- 
tion, capable of accommodating 225 patients. The 
surgical work that is done in this institution by 
the Drs. Mayo and their assistants is so stu- 
pendous in amount and excellent in skill that phy- 
sicians and surgeons from all over the United 
Stales are in constant attendance upon this clinic, 
as well as many eminent surgeons from Europe 
and other parts of the world. My first visit to 
this clinic was made in the winter of 1904, upon 
which visit I was accompanied by Dr. J. Mason 
Hundley. Our reception was so cordial, and the 
work we were able to see was so great and of such 
variety, that I have desired many times to repeat 
the visit. The opportunity, however, did not ap- 
pear to present itself until the first week of Sep- 
tember of this year. Leaving Baltimore upon 
September 4 in company with Dr. Robert P. Bay, 
superintendent of the University Hospital, we 
took our journey toward the Northwest, and 
reached our destination 30 hours later. We 
found a large company of physicians in attend- 
ance on the clinic, exceeding 50 daily during the 
time of our stay. As has been said, these phy- 
sicians were, many of them, prominent men from 



14'' 



THE HOSPITAL BULLETIN' 



various parts of the United States, and several 
were surgeons from European countries. We 
were received with great cordiality, and every 
opportunity was afforded us both to see the opera- 
tions and to inspect the hospital. From 20 to 30 
operations are performed daily, beginning at 8 
o'clock in the morning and ending- usually at 1 
or half-past 1 in the afternoon. These operations 
arc performed usually by Drs. William J. and 
Charles 11. Mayo, who, with Dr. E. S. Judd, are 
the regular operators at the hospital; but many 
operations are also performed by Drs. Beckman 
and Henderson, who are members of the surgical 
staff. Dr. William J. Mayo confines himself 
chiefly to work upon the abdominal organs, and 
he is undoubtedly the greatest abdominal surgeon 
in the world. Dr. Charles H. Mayo devotes his 
attention especially to general surgery, though lie 
is equally at home in any of the other lines of 
surgical work. He is by far the most experienced. 
as well as most skillful, operator upon goitre in 
this country, and his work on this line of cases is 
truly phenomenal, lie is equally at home, how- 
ever, in operating upon the eye or upon the ab- 
dominal viscera, or, in fact, in almost any line of 
surgical work. Dr. Judd, the younger member 
of this aggregation, and who is related by mar- 
riage to the Drs. Mayo, also does an enormous 
work of a great variety. When some of these 
men are absent the work is taken up by other 
members of the stall. Their work is character- 
ized by great celerity as well as by exceptional 
skill, and the visitors at the clinic go from one 
room to another in quick succession, though it is 
absolutelv impossible for one person to see all the 
operations that are clone. I was especially inter- 
ested in the goitre work by Dr. Charles II. Mayo, 
and in four days was able to see 10 or 11 cases 
of goitre operated on of both the simple and ex- 
ophthalmic varieties. It was astonishing to note 
with what ease and safety operations upon these 
difficult cases were performed. By the subcapsu- 
lar method all danger of injuring the parathyroid 
glands and the laryngeal nerves was avoided. I [is 
operations for cancer of the breast are character- 
ized by thoroughness and speed, so that opera- 
tions which in the hands of many require several 
hours for their performance are usually accom- 
plished by him in about 30 minutes. As has been 
said. Dr. William J. Mayo confines his work 
chiefly to abdominal surgery. He is operating 
almost daily upon the stomach and intestines, as 



well as upon the other abdominal organs. W'e 
were fortunate in being able to see performed 
many serious operations upon the digestive or- 
gans, as well as upon most of the other organs 
situated within the abdominal cavity. During 
our visit he performed four partial gastrectomies, 
in which a large portion of the stomach wa- re- 
moved for cancer. W'e also saw several gastro- 
enterostomies, several resections of the caecum 
and sigmoid colon, and were permitted to see the 
cases subsequently in the hospital, and found all 
of them doing entirely satisfactorily. We saw 
three nephrectomies for various causes, one being 
for hypernephroma, which is ordinarily regarded 
as a rare form of kidney tumor, but which Dr. 
Mayo says is the most frequent malignant neo- 
plasm of these organs. A number of gall-bladder 
operations were performed, as well as operations 
upon the urinary bladder, the uterus, ovaries and 
lubes, to say nothing of the vast lot of less serious 
work that was performed daily. The work at this 
clinic is reduced to an absolute system- The vis- 
itors are summoned to the different operating- 
rooms by the ringing of an electric bell, which 
indicates by the number of strokes the room in 
which the operation is about to be begun, and 
visitors are not expected to enter any of the oper- 
ating-rooms until the proper signal has been 
given; but as operations are going on in three 
rooms at the same time, it is impossible for each 
person to view all of the work, and he must see 
that which is most instructive to him. The admin- 
istration of the anaesthetic is done entirely by 
women nurses, and there is very little struggling 
or evidence of difficulty to be seen during the 
administration in comparison with most clinics. 
The assistants are few in number, there rarely 
being more than two in addition to the anaesthet- 
ist and the nurse. The operating-rooms are well 
equip] ied, but are not elaborate, and the excel- 
lence of the results attained is due not so much to 
the superiority of the equipment as to the skill 
of the operators and the excellence of the organi- 
zation. St. Mary's Hospital is conducted by an 
order of Catholic Sisters, and was started just 20 
years ago as a small institution by Dr. William W, 
Mayo, the father of the Drs. William J. and 
Charles H. Mayo, who is still living and hale at 
the age of 01 years. By successive additions and 
alterations the hospital now is practically a fire- 
proof structure of handsome design, with, as has 
been said, accommodations for 225 patients. It 






THE HOSPITAL PULLETIX 



147 



is a marvel to everyone how a work of such mo- 
ment can be done in a hospital of no greater ca- 
pacity than this. Patients are gotten out with 
remarkable quickness, so that but few of them 
remain in the hospital longer than two weeks, 
even after a most serious operation. There is, 
however, a constantly increasing list of patients 
waiting to be operated upon when accommoda- 
tions shall be found for them in the hospital. Fur 
example, we were told that 25 cases of goitre were 
on the waiting list of Dr. Charles H. Mayo and 
15 cases of cancer of the breast were also waiting 
an opportunity for operation. 

The Mayo offices are not at St. Mary's Hos- 
pital, but are located in the Masonic Hall in the 
center of the town, and here a great throng of 
patients are examined and treated by Drs. ( na- 
ham and Plummer and others, and nine-tenths of 
these cases are not surgical and do not come un- 
der the care of the Drs. Mayo at all. At half-past 
2 in the afternoon the Drs. Mayo go to their 
offices and examine such cases as are referred to 
them to determine whether they shall enter the 
hospital to be operated on or not. Most of these 
cases are ambulatory in character and do not re- 
quire immediate attention, and they are obliged 
to take their turn for admission to the hospital. 
A number of specialists are associated with the 
Drs. Mayo in their work at their offices, but most 
of the patients requiring anaesthesia are operated 
on by the regular operators at the hospital. Prob- 
ably from 150 to 200 patients daily are seen by 
the members of the staff at the offices. Not only 
is the medical and surgical work thoroughly or- 
ganized, hut the pathological department is also 
conducted upon the same broad plans as the other 
work of the hospital. Dr. L. B. Wilson is the 
pathologist in charge of the pathological depart- 
ment, and he is assisted in his work by Dr. \Y. C. 
MacCarty and Dr. Margaret Smith. One or 
other of these persons is always within reach dur- 
ing the operating hours, and specimens removed 
from patients are at once submitted to an exami- 
nation. If there is doubt as to the nature of a 
tumor or growth, a frozen section is made and a 
report is returned within five minutes. In their 
museum are 6000 appendices which have been re- 
moved within the last four years ; 1200 goitres are 
likewise preserved, as well as specimens of all the 
organs and structures of the body. The Drs. 
Mavo have built a beautiful library and assembly 



hall for the use of themselves and associates, and 
on every Wednesday night there is a meeting of 
the members of the staff at this hall, to which, 
at times, visiting physicians are likewise invited. 
Here reports and discussions are held in order 
that the latest contributions to medical literature 
may be communicated to all. Whilst many phy- 
sicians visit Rochester for the purpose of attend- 
ing the clinics, when the clinics are over there is 
but little diversion of any kind to be enjoyed; 
consequently a surgeons' club has been formed, 
which meets daily at 3 o'clock in the afternoon for 
the purpose of discussing and further explaining 
the cases that have been under observation dur- 
ing the day. All visiting physicians are not only 
eligible for membership in this surgeons' club, but 
are urged to join it, the admission fee being $2. 
In this manner the irksomeness of the time is, in 
a measure, overcome. At the east end of Roch- 
ester is a large and well-conducted Stale Hospital 
for the Insane, which is not visited by many phy- 
sicians, however. The chief hotel is the Cook 
House, which is a very excellent hostelry at a very 
moderate cost, and it is full to overflowing all the 
time. In addition to this, there has recently been 
erected the Kahler House, which is especially in- 
tended for convalescent patients and their friends, 
hut to which visiting physicians are admitted 
when there is room for them. This is a smaller 
hotel than the Cook Plouse, and is conducted upon 
a more elaborate scale, and naturally is much more 
expensive. The Chute is also a hotel or sana- 
torium for convalescent patients who cannot af- 
ford to pay the charges of the more expensive 
hotels. There are a number of other hotels in the 
town, of the excellence of which I am unable to 
speak, and accommodations can also be had in 
numerous private houses for those who prefer a 
more quiet location. Visiting physicians usually 
stay about a week, so that on each Monday morn- 
ing a practically new company assembles, and on 
Saturday there is a general hegira from the town. 
Enough, however, remain to initiate the new- 
comers into the routine of the clinic. It is with 
great pleasure that I am able to announce offi- 
cially that Dr. Charles H. Mayo will deliver two 
lectures upon the surgery of the thyroid gland at 
the Lmiversity of Maryland in the middle of No- 
vember, which I am sure will be interesting and 
instructive to all who may be able to attend them. 



148 



THE HOSPITAL BULLETIN 



SUBACUTE INFLAMMATION OF THE 

ANTEROLATERAL TRACTS OF ITIF. 

SPINAL CORD AS AN UNUSUAL 

COMPLICATION OF LA-GRIPPE. 



By Joseph W. Hooper, M.D., 



. Issistant Resident Physician, University Hospital. 

Patient white ; male ; age 39 ; fanner ; single ; 
entered hospital giving the following history : 

One year and a half ago patient had a severe 
attack of grippe, with its usual train of symptoms, 
high temperature, persistent headache, photopho- 
bia, general pain and soreness over the whole 
body, etc. He refused to go to bed, and before 
he had entirely recovered from his attack he went 
out. The weather at that time was cold and damp. 
Thinking to protect himself, he wore heavy felt 
boots ; he noticed in a short time that these were 
uncomfortably hot ; he changed them for a pair 
of light shoes; his feet and legs almost imme- 
diately became extremely cold. 

Ten days after this he noticed that his legs 
seemed heavy, and it was with difficult}' that he 
was able to raise them ; this was more marked in 
left lower extremity than in the right. There was 
no pain, but a peculiar drawing sensation. This 
condition gradually became more pronounced. 

Six months ago the patient was given a very 
hot bath. While in the tub the drawing became 
very severe, and he was almost unable to get out 
of the tub and back to his room. 

At time of entrance patient complained of a 
burning and tingling sensation in the calves and 
ankles, numbness in his feet and difficulty in rais- 
ing them from the ground; inability to walk in 
the dark, and a tendency to trip over his feet. 

He also complained of a sense of constriction, 
about two inches above the umbilicus. This was 
especially noted when patient bent forward. There 
was a constant sense of fullness in the stomach. 

He tired verv easily in his lower extremities, 
especially from his knees down. 

At times patient had difficulty in voiding his 
urine ; at other time he was unable to control his 
urine, and frequently soiled himself. The same 
was true as regards the evacuation of his bowel. 

Three days prior to entrance patient jumped 
a distance of 10 feet ; since then he has had a light 
feeling, a sense of constriction over his sacrum. 
Appetite good; no pulmonary symptoms; no car- 
diac symptoms; no urinary or gastrointestinal 



symptoms, save those mentioned. Nothing of im- 
portance obtained from past or family history. 

Physical examination showed a verv well-de- 
veloped white man, five feet 10 and one-half inches 
tall, bony framework (massive), muscles of good 
tone, skin in excellent condition ; expression good ; 
mentality and memory good ; ears low set ; teeth 
in fair condition ; palate normal ; heart and lungs 
normal. 

Upper Extremities. — Motor functions nor- 
mal ; sensory functions normal ; coordination nor- 
mal ; no atrophy. 

Rei lexes. — Triceps, biceps, periosteal and ra- 
dial slightly increased on both sides. 

Trunk and lower extremities abdominal muscles 
normal. 

Extensions normal ; flexions of thighs and legs 
weak ; flexions and extensions of feet normal. 

Sensory Functions. — From a line running 
around the body on a level with the umbilicus in 
front and the twelfth dorsal vertebra behind, to 
the knees, tactile sensation is obtained ; below the 
knees it is absolutely lost. 

From a line running around the body on a level 
with the anterior superior spines of the ilium to a 
point a little above the knees, higher in back than 
in front, sensation of pains is obtained, patient 
being unable to distinguish sharp from dull ; be- 
low the knees it is absolutely lost. 

From a line running around the body on a level 
with the umbilicus in front and the twelfth dorsal 
vertebra behind to a line five inches above the 
knees, temperature sense is obtained : below this 
line it is lost. 

Where sensation can be preceived, muscular 
sense is normal. 

Co-ordination in lower extremities poor; Rone- 
berg's sign present ; no atrophies. 

Reflexes. — Abdominal deficient; tremasteric 
present, but delayed ; patellar reflexes exagger- 
ated ; Babinski and Cordon's reflex present on 
Ik ith sides. 

Tendo achilles exaggerated on both sides ; ten- 
dency to ankle clonus ; abnormal movements. At 
times there are contractions of various groups of 
muscles of the thigh and leg on either side. The 
contractures occur at irregular intervals, some- 
times on the anterior and at others on the poste- 
rior surface. Blood and urinary findings normal : 
tuberculine reaction negative ; spinal puncture and 
N-ray examination negative. 

From the history and examination of the patient 



THE HOSPITAL BULLETIN' 



H') 



we came to the conclusion that we were dealing 
with a condition that was either directly or indi- 
rectly the result of his attack of la-grippe. 

The conditions that suggested themselves were 
multiple neuritis, tabes dorsales, syringomyelia, 
inflammatory changes in the spinal cord, tuber- 
cular pachymeningitis spinalis and syphilitic men- 
nigo-myelitis. 

We excluded multiple neuritis by the presence 
of increased deep reflexes, bowel and bladder dis- 
turbances ; sensory disturbances on the trunk ; sy- 
ringomyelia by the absence of dissociation of sen- 
sation ; trophic disturbances, history of the case, 
etc. Tabes dorsalis was excluded by the history 
of the case, absence of pulpillary disturbances and 
cranial nerve involvement, presence of increased 
reflexes and distribution of the sensory distur- 
bances. 

Tubercular pachymeningitis was excluded by 
the absence of the tuberculin reaction, the radiat- 
ing pains and negative X-ray plates. Syphilitic 
meningomyelitis was excluded by the absence of 
any history of syphilitic infection and the ab- 
sence of improvement on thorough antisyphilitic 
treatment. 

We made the diagnosis of an inflammatory con- 
dition of the anteriolateral portions of the spinal 
cord infections in character for the following rea- 
sons : The condition occurred immediately fol- 
lowing or in the course of an existing infectious 
disease, "La-Grippe," the gradual progression of 
the disease, the character and distribution of the 
sensory disturbances, the presence of bowel and 
bladder disturbances, of increased deep reflexes, 
of the typical Babinski and Gordon reflexes, the 
distribution and type of motor disturbances, the 
absence of atrophies and trophic disturbances and 
the irregular spasmodic contractures of various 
muscle groups. 

The following treatment was recommended : 
Patient was freely purged ; kept quiet in bed for 
two weeks ; counter irritation by means of Spanish 
fly blisters applied over lower dorsal segments of 
the cord, and then when these places were thor- 
oughly healed a light plaster-of-Paris jacket was 
applied to the patient while in extension, this be- 
ing done to immobilize the back. He was also 
given internally Fowler's solution. 

Certain changes have occurred in the spinal 
cord which cannot be rectified, but we can at 
least hope for some improvement and to stop the 
further progress of the disease. 



THE PROFESSORS OF SURGERY IN THE 
UNIVERSITY OF MARYLAND. 



By Randolph Winslow, M.D., 

Professor of Surgery, University of Maryland. 



No. 2. — William Gibson, M.D., LL.D. 

The second incumbent of the chair of surgery 
was Dr. William Gibson, who was elected to this 
position on the 6th of April, 1812, when he was 
but 24 years of age. He continued to hold this 
chair until 1819, when he was called to a similar 
position in the University of Pennsylvania. Dr. 
William Gibson was born in Baltimore on March 
14. 1788. He was educated at St. John's and 
Princeton colleges, and began the study of medi- 
cine at the University of Pennsylvania, but in 
1806 he went abroad and entered the University 
of Edinburgh, and graduated there with the de- 
gree of M.D. in 1809. Subsequently he went to 
London and became a pupil of Sir Charles Bell, 
who was at that time a famous surgeon in the 
English metropolis. Soon thereafter he went to 
the seat of war in Spain and was present at the 
battle of Corunna. He returned to Baltimore in 
1810. and at once took a prominent professional 
position here. In 1812 he was made professor of 
surgery in the medical school, and during the 
summer of that year he performed the first liga- 
tion of the common iliac artery on record. This 
was upon a man who had received a gunshot 
wound of the abdomen during the riots in Balti- 
more. In addition to the injury to the artery, the 
intestines were wounded in two places, and each 
opening was closed with a ligature. The patient 
died on the fifteenth day from ulceration of the 
artery and peritonitis, but this operation estab- 
lished his reputation in surgery. In 18 14 he again 
went to Europe, and, being in the vicinity, was 
present at the battle of Waterloo, where he was 
slightly wounded. He was also a surgeon to the 
Maryland troops during the War of 1812. Whilst 
clinical facilities were limited during the time 
that he was professor of surgery in the University 
of Maryland, he occasionally performed opera- 
tions in the presence of his classes at the Maryland 
Hospital on Broadway, which occupied the same 
location that is now held by the Johns Hopkins 
Hospital. He was also surgeon to the Almshouse, 
which was located about the present situation of 
Howard and Madison streets, and at times held 



150 



THE HOSPITAL BULLETIN 



clinics at this institution. He was said to have 
been an attractive teacher, with a distinct and 
melodious voice, and expressed himself in grace- 
ful and well-chosen language. He was a rapid 
and dexterous operator, and possessed great me- 
chanical ingenuity. He was likewise a skillful 
worker in wax, a fine artist and a musician of no 
small ability. He was also a highly educated man 
with a predilection for the classics. In 1819 he 
left Baltimore for Philadelphia, where he had 
been called as professor of surgery in the Univer- 
sity of Pennsylvania. He continued to fill this 
chair until 1854. He died in Savannah, Ga., on 
.March 2. 1868, aged 80 years. He was twice 
married, having several children by each wife. 
< >ne of his sons, named Charles Bell Gibson, after 
his friend. Sir Charles Bell, the London surgeon, 
became a distinguished surgeon and professor in 
the Washington University of Baltimore, now 
merged with the College of Physicians and Sui- 
geons, and the Medical College of Virginia at 
Richmond. Dr. Gibson was represented to have 
been of robust frame, broad shoulders, full face 
and ruddy complexion. After his removal to 
Philadelphia he became one of the most eminent 
surgeons in the United States, and performed 
many operations of great magnitude and impor- 
tance. Amongst these was Caesarean section per- 
formed twice on the same woman, saving both 
mother and children. He also extracted a ball 
from General Scott that he received at the battle 
of Lundv's Lane during the War of 1812. He 
was the author of an elaborate treatise on surgery, 
in two volumes, which went through eight or nine 
editions. According to Professor Gross, he was 
an accomplished lecturer, lucid writer and able 
surgeon. The removal of Professor Gibson to 
Philadelphia was a great loss both to the Univer- 
sity of Maryland and the city of Baltimore. The 
University of Edinburgh, in appreciation of his 
distinguished career, conferred on him the hon- 
orary decree of LL.D. 



THE ETK )L( >GY < >F CHOREA. 



By II. D. McCartv. M.D., of Baltimore. 

Tn discussing the etiology of Chorea Minor, I 
beg to present the following observations, which 
have been drawn from numerous sources, and 
though I have been unable to find anything con- 
clusive, the studies of the various writers, showing 



the striking similarity of the hypotheses to which 
they hold, strongly suggest the malady to be of 
an infectious nature. 

To those who are interested in the views of 
earl}- observers as to the cause of chorea, I would 
refer them to an article in The Johns Hopkins 
Bulletin, 1901, by Dr. H. M. Thomas, entitled 
"Chorea With Embolism of the Central Artery of 
the Retina," giving a short review of the embolic 
theory. 

Dr. Thomas quotes Kirkes in this article, as 
follows : By the mere circulation of morbic blood 
through the nerve centres parti}-, also by tempo- 
rary obstruction in the minute capillaries occa- 
sioned by fibrinous particles arrested therein, the 
irritation leading to the development of chorea or 
other analogous phenomena may be accounted for. 
In this same article it is stated Roger, in France, 
r886, went so far as to state that rheumatism, cho- 
rea and endocarditis were all manifestations of the 
same poison. 

I have myself often thought whether chorea 
was to be regarded as a disease or as a symptom 
of an infectious condition, in which, endocarditis 
and metastic arthritis played an essentially impor- 
tant part. 

Working in Dr. Thomas' clinic at the Johns 
Hopkins Dispensary, I had the opportunity of ob- 
serving quite a few cases of chorea minor, and one 
could not help be impressed with the constancy 
with which that malady was associated with the 
sore throat, arthritis and endocarditis. The tem- 
perature of the chorea patient was reguarly taken 
and its absence rarely noted. 

Dr. Thayer, in an analysis of 808 cases pub- 
lished in A. M. .1. Journal, 1906, showed in 689 
of these cases that 25.4 per cent, had evidences of 
cardiac involvement. 

Wyss — fahrbuch fur Kinderheilkunde, Berlin, 
H)o8 — studied 51 cases of chorea minor at Zurich 
( 1874-1Q07). In 41, that is 80.4 per cent., a cer- 
tain connection between chorea and acute articu- 
lar rheumatism or endocarditis was evident, either 
in the patients themselves or in their parents. 
brothers or sister. Rheumatism had preceded cho- 
rea in 16 of the 51 children, that is in 31.3 per 
cent., while rheumatism followed the chorea later 
in 40 per cent, of the 35 children, whose later his- 
tory was known. Endocarditis was observed at 
the time or later in 54.3 per cent, of the 51 chronic 
children. He calls chorea, rheumatism and endo- 
carditis the three acts of a simile drama. 



THE HOSPITAL BULLETIN 



LSI 



Duckworth — B. M. /., June 23, 1906 — reit- 
erates his belief that chorea is a variety of rheu- 
matism, which more particularly involves the 
brain. He says that the evidence in favor of the 
rheumatic nature of chorea is stronger, if possible, 
from the clinical than from the bacteriological 
side. Chorea is more frequently seen in families 
prone to rheumatism. It may precede .by months 
or years an onset of rheumatic fever, or it may 
supervene during an attack. His statistics show 
a family or personal history in 85 per cent, of 
cases of chorea. 

Cotton — "Textbook on Disease of Children," 
1906 — says : "The mode of onset, the self-limi- 
tated character of the attack, the accompanying 
anemia, the subsequent heart lesions and its tend- 
ency to recurrence, all stamped chorea as a phase 
of rheumatism with more than a suggestion of 
microbic etiology." 

In "Pfaundler and Schlossman's Textbook on 
Disease of Children," 1008. Wollenberg writes: 
"A definite relation has been established be- 
tween chorea minor, rheumatism and endocardi- 
tis. This connection is not observed in other 
forms of chorea, and strongly suggests that chorea 
is to be regarded as an infectious disease." 

A few authors ( Laufenauer, Tribuolet, Bechte- 
rew and others) always refer it an infectious 
cause, and look upon the other factors as exciting 
causes. Positive evidence of micro-organisms in 
the brain of choreics have been found in but few 
cases (results of Richter, Berkley, Dana, II. 
Meyer, Pianese). 1'ianese found a diplococcus 
and a diplobacillus, cultures of which produced ex- 
perimental chorea. 

Holt says: "The relation of chorea to rheuma- 
tism is most striking, and of late has attracted 
much attention. The results of different writers 
are somewhat at variance. Some have found evi- 
dences of rheumatism in but a small proportion of 
the cases (5.10 per cent.), while others have 
placed the statistics as high as 50 or 60 per cent. 
I* is rather striking." Holt says: "The statistics 
of neurologists, almost without exception, have 
given a very much smaller percenage of rheuma- 
ism in chorea cases than those taken from chil- 
dren's clinics and hospitals." He says the ques- 
tion hinges largely upon what is to be considered 
as evidence of rheumatism in a child. If cases 
of acute articular inflammation only, then the 
number will be small : if subacute cases, with 
joint swelling, are included, the proportion will be 



considerably larger, while if we admit cases of 
acute endocarditis without articular symptoms, 
and those of articular pain and joint stiffness with- 
out swelling, the proportion will be much in- 
creased. He believes there is a close connection 
between chorea and rheumatic diathesis as mani- 
fested by symptoms above noted and accompanied 
by a family history of rheumatism. There seems 
then to be a large group of cases which may be 
classed distinctly as rheumatic chorea. There are, 
however, many others in which no such element 
can be found. , 

The analysis of 146 cases by Crandall, quoted 
by holt, showed the following result : — 

Definite history of rheumatism, 63 cases. 

Rheumatism occurred before chorea, 41 cases. 

Rheumatism and chorea coincident, 13 cases. 

Rheumatism subsequent to chorea, 9 cases, usu- 
allv within three months. In one-third of cases 
attacks of rheumatism occurred during or subse- 
quent to the chorea, as well as before it. Then 
previous rheumatism was evident in 37 per cent., 
concurrent in 24 per cent., subsequent in 15 per 
cent. Excluding cases mentioned twice and all 
those in which there was only a history of growing 
pains, there was evidence of articular rheumatism 
in 56.7 per cent. Many of these patients, Crandall 
states, have now been under observation for sev- 
eral years, and it has been interesting to see, as 
time has passed, how evidences of rheumatic dia- 
thesis have multiplied, the longer the cases have 
been observed. 

Holt says : "If cases of endocarditis without ar- 
ticular svmptoms were included, as I think they 
might fairly be, it would raise the proportion of 
rheumatic cases still higher. The great proportion 
of cardiac murmurs persisting after chorea, if not 
all of them, should, 1 believe, be classed as rheu- 
matism, even if no articular symptoms have been 
present. " 

Guthrie Rankin— B. M. /., 1908 — says: "The 
peculiar and intimate association which exists be- 
tween chorea, cardiac disease and rheumatism is 
well recognized, but the relationship has not yet 
been established." 

Morley Flecher, quoted by Rankin, concludes 
from a study of 580 cases that chorea is a mani- 
festation of rheumatic fever, but that many other 
causes may cooperate in the production of the 
disease. Rankin further states when rheumatism 
attacks children it tends to exert its influence more 
on the heart and pericardium than on the joints. 



152 



THE HOSPITAL BULLETIN 



so that if care be not taken to seek for evidence of 
endocarditis of pericarditis the true association of 
chorea with the rheumatic poison may be over- 
looked. In fatal cases one or more of the cardiac 
valves are found diseased, and the interdepend- 
ence of chorea and rheumatism in the vast major- 
ity of the cases is now generally admitted. There 
seems little doubt that both depend upon the same 
or closely allied micro-organisms. 

Legay of Paris published statistics in 1897 
which went to show that the disease occurs for 
the most part in children with a neurotic heredity 
who have recently suffered from an infectious dis- 
order. In the majority of the instances the in- 
fection was rheumatic, but he quoted many cases 
in which chorea was apparently directly due to 
the poisons of measles, scarlet fever, influenza 
and tuberculosis. 

Sturges has pointed out that it is not an uncom- 
mon sequelae of whooping-cough. 

Nearly all writers agree as to the age the dis- 
ease is most common. It rarely occurs under 5 
years. Fifty per cent, of all cases are met with 
between 5 and 10 years. Another 30 per cent, be- 
tween 10 and 15 years. It attacks girls three times 
more frequently than boys, and after the second 
decade the per centum of females increases. 

Holt gives in 14O cases 6 under 5 years, 7.2 
between 5 and years, 68 between 10 and 14 
years. 

Carpenter, in the B. M. J.. 1906. reports a case 
of rheumatism with chorea in a child three and a 
half years old, with hyperpyrexia. Mitral murmur 
was present and numerous subcutaneous nodules 
the size of small beans. Optic neuritis later devel- 
oped, the child dying about 8 weeks after the on- 
set. 

Wollenberg points out that girls are more often 
attacked by severe forms. 

As to season, it is more prevalent in the cold, 
wet months. Holt says "it may be seen at all 
seasons, but is more frequent in the spring." Of 
717 cases studied by Lewis of Philadelphia the 
largest number began in March. The next largest 
in May. In Holt's cases May stood first. Certain 
families are specially predisposed ; mostly those 
in which a rheumatic and neurotic inheritance 
are combined. 

Rankin states a general nervous disposition is 
noted in 20.30 per cent of cases. He further 
states the relation between neuropathia and cho- 
rea is bv no means clear. It is not to be denied 



that febrile diseases or chronic nutritional disturb- 
ances, which lower the resistance of the entire or- 
ganism, and therefore of the nervous system, 
might produce a certain predisposition to the in- 
toxication or infection which manifests itself as 
chorea. 

By some writers reflex irritation, such as that 
produced by dentition, intestinal worms, errors of 
refraction, etc., is held responsible for choreic 
manifestations. 

It must be borne in mind that much confusion 
has existed in the minds of many as to what is to 
be called chorea, and no doubt that irregular 
movements arising from above-mentioned irrita- 
tion might be tics pure and simple. 1 would direct 
your attention to differential points cited by Meige 
and Feindal in their book on "Tics and Their 
Treatment." 

Children who have suffered from one attack 
are liable to a recurrence. Rankin states the prox- 
imate cause is probably a micro-organism similar 
to that of rheumatism, the toxins of which are re- 
sponsible for the nervous manifestations with 
which we are familiar ; but even if this hypothesis 
be ultimately confirmed, it must be admitted that 
the direct excitant of an attack is in many in- 
stances some form of mental disturbance. In chil- 
dren fright is the most acute of all emotional 
states, but it is conceivable that excessive joy or 
sorrow may act in a similar detrimental way on 
those suitably predisposed. It is not impossible 
that the emotional excitant may be responsible 
for two varieties of the disease, according as the 
child harbors the rheumatic micro-organism or 
not ; that in one instance, and that the more fre- 
quent, it may be rheumatic manifestation and in 
the other neurotic. 

Gowers states that 25 per cent, of all cases are 
due to fright, and that in his experience the in- 
terval between the fright and the development of 
muscular movements rarely exceeds a week. 

Sturges (and many observers agree with him) 
regards the disease as a functional expression of 
nerve irritability induced by numerous extrane- 
ous causes, and urges in favor of this view the re- 
markable limitation of the disease to the period of 
childhood, its preference for females, and its on- 
set at a time when the requirements of growth 
and education are exciting a strong demand upon 
the resisting power of the sensori-motor ganglia. 

Finally, there are not wanting advocates of the 
microbic origin of the disease, and it has been 



THE HOSPITAL BULLETIN 



153 



found that the diplococcus, isloated by Poynton 
and Payne from the joints of patients with acute 
rheumatism, is capable of producing, when in- 
jected into rabits, not only arthritis, but endocardi- 
tis ; but in some instances also a form of chorea. 
Sections of the cerebral cortex of an animal thus 
rendered choreic have revealed masses of diplo- 
cocci in connection with the small arterioles. The 
probable entry of the organisms through the deli- 
cate mucous membrane of the naso-pharynx has 
been suggested as a possible explanation of how 
infection may occur, and there can be no doubt 
that the disease occurs in association with several 
types of sore throat. 

M. de Ponthiere ( "Annales de Medecine et 
Chirurgie Infantiles," Paris) : After ten years' 
observations, comments on the rapid and perma- 
nent cures obtained by removal of tonsils and 
adenoids which are chronically affected, his con- 
clusions are that chorea is generally the outcome 
of an auto-intoxication produced by swallowing 
septic material secreted by the lymphoid organs of 
the naso-pharynx. The naso-pharyngeal infection 
is nearly always rheumatic. The pharynx is 
nearly always responsible for the cardiac and arth- 
ritic manifestations of rheumatism which follow 
on septic sore throats. The author adduces the 
analogy of other local and general symptoms 
which are common to adenoid and choreic pa- 
tients, such as deficient nasal respiration, disturbed 
nights, night terrors, dyspnea, muscular and intel- 
lectual disabilities, difficulty in concentrating the 
attention, alterations in the character, digestive 
disturbance, distaste for food, especially in the 
morning; lymphatism, and the stupid aspect of 
the choreic, which is the same as the adenoid fa- 
cies. The examination of the naso-pharynx is 
thus of the greatest importance in cases of chorea, 
as the origin of the neurosis will be often dis- 
covered there. 

The influence on chorea of suitable treatment of 
the nose and throat will convince the most skep- 
tical, he says, of the unmistakable connection be- 
tween them. 

In connection with the possibility of chorea be- 
ing due to a toxin, I would like to call attention to 
the experiments by Phisalix on sparrows. He 
found that the bee sting produced in them true 
choreiform movements, in which the muscles of 
the feet, head, wings and eyes were affected. 

The association of chorea with pregnancy is by 
no means rare. It seems to occur in those who 



have had chorea or some manifestation of rheu- 
matism previously. 

In the Deutsche Medisinische Wochenschrift, 
Berlin and Leipsic, 1906, Martin reports a case of 
chorea with pregnancy. During the first preg- 
nancy the patient had acute articular rheumatism. 
The subsequent pregnancies were attended with 
chorea, which reappeared with each succeeding 
pregnancy with increased intensity. 

From the facts that chorea occurs more fre- 
quently during that season of the year when the 
mucous membranes are mostly to be infected, oc- 
curring in children at that period of life when they 
are most liable to throat trouble ; the disease being 
many times associated with conditions known to 
be infectious ; the febrile course of the disease ; all 
strongly point toward chorea being an infectious 
r.ialadv. 



CORRESPONDENCE 

A TRIP TO RICHMOND, THE CAPITAL OP 
THE COMMONWEALTH OP VIRGINIA 
AND THE SECOND CAPITAL OF THE 
CONFEDERACY, PETERSBURG AND WIL- 
LIAMSBURG. THE SECOND CAPITAL 
OF VIRGINIA. 

Editor of Bulletin. 

Embarking on the good steamer Atlanta of the 
York River Line I left Baltimore, Saturday, July 
Ml, 1909, ;it "< 1'. M.. and sailed down that magnifi- 
cent body of water, the Chesapeake, reaching West 
Point, Virginia, the next morning at 8 A.M., 
thence entrained on the Southern Railroad and 
reached my destination at 9.30 A. M. The country 
I iet ween the York and the James Rivers, is flat, 
sandy and not well cultivated, but pleasing to the 
eye ; only here and there did I see fields of corn, 
nor is it apparently thickly populated. The 
greater part of the train trip was passed through 
scrub woods of pine, oak, holly, etc. The journey 
took us over the Pamunkey, a broad, shallow, 
picturesque river and a feeder of the York. Rich- 
mond, founded in 1737 by Colonel William Byrd 
and incorporated as a town (17-42), is at the head 
of tidewater and navigation. Situated on the 
north bank of the James on a series of terraced 
hills, it contains much of historic value to interest 
the stranger. The panorama, from the Seven 
Hills, of the Valley and of the Falls of the James 



154 



THE HOSPITAL BULLETIN 



is superb and pleasing. Here John Smith and a 
companion landed after they had left their fol- 
lowers at Jamestown Island — the first capital of 
Virginia — the Falls of the James barring further 
progress to their journey. 

During the Revolutionary War La Fayette had 
his headquarters for a time in the city of Rich- 
mond, the building, an old stone house, being still 
in an excellent state of preservation and located in 
the eastern section or old part of the city. It is 
claimed that Washington visited the Count in this 
building, whence it is called Washington's head- 
quarters. Tarlton and Arnold during the Revolu- 
tion raided as far inland as Richmond. 

But it is the stirring and eventful part Rich- 
mond played in the Civil War that chiefly con- 
cerns the visitor. Here many of the Confederate 
soldiers of the Civil War were mustered into 
service; here the last scenes of that great contesl 
culminated in the disaster and ruin that left large 
sections of the city in ashes: here today one sees 
everywhere the results of the energy which has ef- 
faced the signs of those troublous times: and the 
enterprises which have tripled the population, 
which is now rated as 125,000, against 37,910 in 
1860. 

The White House of the Confederacy, the war 
time residence of the Confederate President. Jef- 
ferson Davis, at the coiner of Twelfth and Clay 
streets, is now a Confederate Museum and Memo- 
rial Building. The house, an old fashioned resi- 
dence, was built in 1819, and bought by the city of 
Richmond for the use of the Confederate Govern- 
ment. During the Federal occupation it was used 
by General Witzel as headquarters, but with the 
revocation id' martial law, the city of Richmond es- 
tablished its first public school in it: for which 
purpose it was employed until 1890, when it was 
turned over to the Confederate Memorial Literary 
Society, who have entirely renovated the building 
and restored it to its erstwhile appearance. With 
but one or two exceptions no relic has been pur- 
chased. Each Confederate State is represented by 
a Room, set apart as a memorial to her sons and 
their deeds. The relics and books are invaluable 
and a fitting testimonial to the valor and manhood 
of our Southland. In order to meet running ex- 
penses an admission of 25 cents is charged. 

St. Paul's Church, at the corner of Grace and 
Ninth streets, is of interest. I'm' here it was Presi- 
dent Davis while at worship received news from 
Lee that the city must be evacuated. In this build- 



ing are memorial windows erected to the memory 
of Lee and Davis. Lee's old headquarters are on 
Franklin street between Seventh and Eighth. The 
famous Libby Prison has been removed to Chicago 
and a factory erected on its site. 

In Hollywood Cemetery, so called from the 
abundant and luxuriant growth of holly, at the 
western edge of the city are buried Davis, Pickett, 
Stuart, Presidents Monroe, Tyler and Madison and 
many other distinguished personages. Here is to 
lie -een a massive pyramid of stone erected to the 
memory of the Confederate dead and monuments 
upon the burial sites of those just mentioned. We 
of the South should feel an especial gratification in 
the beautiful and quiet resting place of President 
Davis. 

Capitol Square enclosing ten acres of ground is 
a beautiful spot, adorned with trees, flowers, foun- 
tains, and historic buildings. Here upon an eleva- 
tion, is located the Capitol, plain in character, with 
walls of stuccoed bricks and a portico with mas- 
sive columns, and designed after the Pantheon. 
Within its walls the Confederate Congress met. In 
the Rotunda is Houdon's celebrated Statue of 
George Washington. It houses the offices of the 
Governor, and a room in which there is an exhibit 
of the products of Virginia. In this building is 
also to be seen the speaker's chair from the Colo- 
nial House of Burgesses. 

Besides the Capitol this square contains within 
its enclosure, the Governor's Mansion, colonial in 
style, the Library Building, recently completed. 
Washington, Clay. Smith. Jackson and Hunter Mc- 
Guire Monuments, and the old Bell House. On 
Franklin street are to lie seen monuments to Lee, 
Davis and J. E. B. Stuart. Many other objects 
and points of interest abound. Old St. John's 
Church, where Patrick Henry delivered his famous 
speech "Give me liberty or give me death" is 
open to strangers free of charge. If you are look- 
ing for historical places and incidents, go to Rich- 
mond. Here you will get your surfeit. 

From a material standpoint Richmond is also 
interesting to the traveler : nearly forty-five years 
ago it was almost annihilated by fire. Today, are 
to be seen no traces of this great conflagration, 
factories, stores, public buildings not only cover 
the destroyed area, but extend miles in other direc- 
tions. It is above all a clean city, and is away 
ahead of Baltimore in this respect. Its streets are 
paved either with asphalt or belgium blocks, oc- 
casionally with vitrified bricks. No cobblestones 



THE HOSPITAL BULLETIN 



155 



are to be seen. Much to her credit there is no sur- 
face drainage. Baltimore could indeed take a les- 
son. The number of two-stoTy houses are striking. 
There are some modern residences in the western 
part of the town. On Grace street, the aristocratic 
neighborhood, the houses are no two alike, colonial 
in structure mostly, with some veranda, and sur- 
rounded with a little grass or flower plot. Even 
the less pretentious houses have some ground in 
front of them and I did not see in the residential 
quarter during my stay a solid row of houses such 
as we have in Baltimore. 

Crepe Myrtle, in bloom, and magnolia trees are 

to be seen on every side. The holly and fig 
tree flourish here as nowhere else. Hotel accom- 
modations are good and reasonable. For visitors 
bent on sight seeing the Murphy or the Richmond 
Hotel are centrally located, their rates moderate 
and service excellent. The street car service is un- 
excelled, and reaches all points of interest, as well 
as surrounding suburbs. Transfers are freely is- 
sued and a transfer is given on a transfer. Rich- 
mond is however poorly lighted. 

Of no doubt of more importance to you, as medi- 
cal men. will be a short account of the medical 
colleges of Richmond, of which there are two. the 
Medical College of Virginia, the older, and the 
University College of Medicine, the younger of the 

two. and an offsl t of the former. Both embrace 

departments of medicine, dentistry and pharmacy, 
and both have a student enrollment of approxi- 
mately 350. 

The Medical College of Virginia, is located at 
the corner of Marshall and College streets. It was 
founded in the year 1838. At first this institution 
was a part of Hampden-Sidney College, but in 
1854 it was chartered as a separate institution. It 
has a continuity of existence as its doors were not 
closed during the war between the states. The 
main building, modeled after the Egyptian style of 
architecture, is large and imposing. In it there 
are a number of classrooms. The laboratories are 
in another building, the former old Dominion 
Hospital, the clinical instruction now being given 
in Memorial Hospital, an imposing structure, 
corner Twelfth and Broad streets. This hospital 
is built externally of terra cotta bricks. Its in- 
terior is tastefully arranged and furnished, its 
amphitheatre roomy and its walls partially tiled, 
the floor of terrazza. There are several other 
operating rooms, an excellent and up-to-date X-ray 
and electro therapeutic outfit. This hospital holds 



about 150 patients when full. As the State of 
Virginia and the City of Richmond make no pro- 
vision for charity cases this hospital as well as 
Virginia Hospital connected with the University 
College of Medicine, are forced to curtail their run- 
ning expenses and during the summer months arc 
obliged to close their public wards. The wards 
are large, well ventilated and comfortable, and the 
private rooms which range in price from 7 to as 
high as 25 dollars per week are very attractive. 
The kitchen is on the top floor. Here I saw a 
slight operation by Dr. Horslev. a rising young 
surgeon of Richmond. The technique was excel- 
lent and all concerned seemed to be familiar with 
their part. 

Coming hack to the school the laboratories were 
fairly well equipped and ought to be able to do 
good work. A small library attached to this in- 
stitution was housed in a Large room, but as far 
as I know had no regular librarian. The dis- 
pensary was in the basement of the laboratory 
building. Considering that the school is not en- 
dowed, it should and in all probability is doing 
good work. 1 was very much impressed with its 
appearance and its potentialities. Mr. McCauley, 
the secretary of the Board was very attentive and 
courteously showed me through the buildings. He 
also explained to me the inner workings of his 
office and I assure you it was very business like. 
As far as possible he keeps a card index system of 
the address of each and every graduate. The 
grades arc kept on the loose leaf ledger system 
and at the end of the fourth year, these are bound 
into a volume and filed away. 

The University College of Medicine, founded in 
1893, is housed on Clay and Twelfth streets. It 
was chartered as a joint stock company, hut in 
10()4 another (barter was conferred upon it, chang- 
ing it from a private enterprise to an institution 
governed by an independent hoard of trustees. 
The buildings are large and occupy approximately 
half id' a city block. The lecture rooms are com- 
modious and the laboratories should apparently be 
able to render a good account of themselves. In 
this institution there was a Pasteur department. 
On the whole the appearance of the buildings did 
not strike me as favorably as those of the Medical 
College of Virginia. The Virginia Hospital, the 
clinical part of the institution was housed in two 
old colonial houses which bail bad their dividing 
partition knocked out, and enlarged as occasion 
demanded by several additions. The private rooms 



K6 



THE HOSPITAL BULLETIN 



appeared cosy and comfortable, the wards well 

kept, and the whole institution was in shipshape 
order. Here I saw a case of pellagra, and a 
colored woman recovering from a decompression 
operation. Both the Hospital and the University, 
however, had the air as if they were suffering from 
hampered finances. 



PETERSBURG. 
Petersburg is to the south of Richmond and con- 
veniently reached either by the 14th or 7th street 
trolley for Manchester, where a change is made 
to the Petersburg line. The price of the trip is 
40 cents each way. This town is situated on the 
banks of the Appamatox River. It is hilly. More 
space intervenes between the houses, but it is 
smaller than Richmond. The remains of the 
Crater, filled with trees, whose trunks in some in- 
stances are as large as a man's body, is to be seen. 
Old Blandford church near the Crater and in 
which are buried some of the victims of this en- 
gagement, is well worth inspecting; memorial 
tablets and windows being numerous. One of the 
windows is to the North Carolina troops, of whom 
more than 45,000 were killed during the war, with 
Lee's epitaph, "Cod bless North Carolina." The 
court house is a quaint old building. There were 
some very pretty and pretentious homes in this 
city. 



WILLIAMSBURG. 

Williamsburg the second colonial capital, is in- 
deed a very interesting, instructive and entertain- 
ing spot. Situated on the peninsula between the 
York and James Rivers, it is reached from Rich- 
mond by the Chesapeake and Ohio Railroad, the 
ticket being $1.20 each way. It is about seven 
miles from Jamestown Island. In 1699, owing to 
the burning of the State House at Jamestown, the 
seat of government was removed to Williamsburg. 
The remains of Martha Washington's kitchen, 
namely the chimney, is still standing. The old 
Court House is an object of interest. William and 
Mary College, founded in 1693, is located in this 
town. The main building was fired by the 
Federals and almost completely destroyed. As 
far as possible in the rebuilding the old walls anil 
bricks were used. The buildings of this institu- 
tion are very quaint. Many distinguished men 
have been students at William and Mary, among 
whom may be mentioned Patrick Henry, Chief 
Justice Marshall, President Monroe, General Win- 



field Scott. It was in this town that the im- 
mortal George Washington first met his future 
wife, Mrs. Custis. 

The foundation of the House of Burgesses is 
still to be traced, and a tablet marks the spot. The 
crowning glory of Williamsburg, however, is Bru- 
ton Church, the oldest Episcopal Church in con- 
tinuous service in America. Here five presidents 
have worshipped: Washington, Jefferson, Madi- 
son, Monroe and Tyler. During colonial times the 
Governor and members of the House of Burgesses 
worshipped here. King Edward recently pre- 
sented a bible to the church and President Roose- 
velt has given an electra on which the bible is to 
rest. The church is constructed on the plan of a 
letter H and is finished with a mahogany effect. 
The pews are dedicated to the worthies of the past, 
many of whom are buried under the floors. The 
janitor, William, a colored man, was very polite. 
He had at his finger's end the life history of each 
and every celebrity whose life had happened to be 
interlinked with that of the church. Washington's 
step-children are interred in the churchyard. In 
I his town is also to be seen Washington's head- 
quarters, the Old Powder Horn, wherein the am- 
munition was stored — it has now- been converted 
into a Colonial Museum — and the Eastern State 
Hospital, the first insane hospital in the United 
States. 

Natiiax Winslow. 



To the Editor : 

Why not a "Booster Club" or "Praise Your 
Brother Club" in the American Medical Associa- 
tion, with no dues or other requirements except 
that each member pledge himself never to speak 
unkindly or in criticism of a brother physician 
to the laity, except that physician be also present. 
Let us renew our vows and wear buttons to show 
that we mean to keej> them. 

If such a condition could be brought about we 
would he held in much greater esteem by our 
patients and neighbors. Whenever a physician is 
condemned, maligned or criticised by another phy- 
sician, the ill-will engendered in the minds of the 
laity is not against the one physician, but the class; 
individuals are forgotten and the profession is re- 
membered as a whole. If I tell every one I meet 
that Dr. Pill is a rank physician ; knows nothing 
of medicine and will stoop to any mean practice, 
the laity soon forget that Dr. Pill is a "poor 



THE HOSPITAL BULLETIN 



1 57 



doctor" and retain the impression that we are 
all "poor doctors" ready to stoop to anything. 

Let's stop it; raise the standard. Can we get 
together at St. Louis and organize a club? 
Yours for "no knocking," 
W. T. Woottox. M. D., 

Hot Springs, Ark. 
The above from the Journal A. M. A. of Au- 
gust 7th, '09. 

Will you agitate such a scheme to the end that 
we may create a better general impression upon 
the laity, restore confidence in our profession and 
take away the foundation for so many pathics. 
religeo-cures, etc.? 

Very sincerely yours, 

W. T. WoOTTON. 

The Bulletin will be glad to receive members 
to Dr. Wootton's club. 



ITEMS 

Doctor Joshua W. Hering has been renominated 
as State Comptroller by the Democratic Organiza- 
tion of Maryland. Doctor Hering was a member 
of the class of ls.")o. and is a resident of West- 
minster, Maryland. 



Doctor W. M. Pearce is spending his summer 
vacation at Atlantic City with his family. 



Doctor John I'. Winslow, Clinical Professor 
of Diseases of Nose and Throat, has returned from 
his summer vacation, which was spent at Cape 
May, New Jersey. 



Doctor C. W. McElfresh, Clinical Professor of 
Medicine, lias returned from his summer vaca- 
tion, which embraced a trip to West Virginia 
and Pittsburg. In the latter city he saw some good 
work in cranial surgery. 



Doctor Randolph Winslow, Professor of sur- 
gery, has left on a trip to the Mayo brothers in 
Rochester, Minnesota. He will be accompanied 
by Doctor Robert Bay, superintendent of the Uni- 
versity Hospital. 



Doctor and Mrs. Nathan Winslow have returned 
from Richmond, where they spent some time vis- 
iting points of historic interest. An account of 
the trip appears elsewhere in this number. 



University Hospital, is located at Sandy Spring, 
Montgomery county, Maryland. It was the pleas- 
ure of one of the editors to pay him a flying 
trip and he appears to he making a success of 
practice. 



Doctor Walter Scott Carswell is stopping at the 
Chalfonte, Atlantic City. 



Doctor and Mrs. Norman F. Hill have returned 
to Baltimore from a visit to their son, at Buffalo, 
New York, and will move to their apartments at 
the Walbert, September 1, 1909. 



Doctor John C. Keaton, class of 1907, of Quiucy, 
Florida, is the guest of Doctor J. L. Valentini, 
130-.' N. Broadway, Baltimore. 



Doctor John A. Tompkins has returned to his 
home after a fortnight's stay at liar Harbor, where 
Mrs. Tompkins is spending the summer. 



Doctor Ariste W. Giampietro, class of 1907, of 

Baltimore, lias been appointed physiologist in the 
Bureau of Plant Industry, at Washington. 

Doctor Gianpietro is 38 years of age ami prom- 
inent among the Italian contingent of the city. 
lie is the organizer and head of the Republican 
Organization known as "Young Italy." He lives 
at 3007 Baker street. Walhrook, Baltimore. The 
appointment came as the result of the successful 
passing of a civil service examination. 



We are more than glad to announce to the many 
friends of Doctor Lawrence Kolh. class of 1908, 
and an ex-resident of the University Hospital, 
where he did exceptionally good work, that he has 
passed the examination for the Public Health and 
Marine Hospital Service, and has received a com- 
mission as assistant surgeon. He has been or- 
dered to report to medical officer in charge at 
Baltimore for assignment to dulv. 



Doctor and Mrs. J. Frank Crouch have left 
Bretton Woods, New Hampshire, and will spend 
several weeks at Lenox, Massachusetts. 



Doctor and Mrs. Francis Jannev, of Catons- 
ville, Maryland, are at Atlantic City. 



Doctor J. W. Bird, ex-resident physician to the 



Doctor Fitz Randolph Winslow. class of 190G, 
spent his vacation at Lurav Cave, Virginia. 



THE HOSPITAL BULLETIN 



Dr. William K. White, class of 1902, who was 
operated on recently at the University Hospital, 

has made a g I recovery and left the institution. 

Doctor White is one - of the mosl popular of the 
younger physicians connected with the University 
Hospital and the news of his recovery will be 
h elcomed by his many h tends. 



Doctor A. G. Pole and family, of Baltimore, 
have left for Atlantic City, where they will be 
the guests of the Chalfonte for several weeks. 

Doctor William IT. Smith, 'class of 1900, ex- 
resident physician and surgeon to the University 
Hospital, and formerly superintendent of the He- 
brew and Bay View Hospitals, broke his leg re- 
cently while engaged in a game of baseball between 
the internes and the dispensary staff. 



Doctors J. X. Reik and T. Chow Wbrthington 
have sailed for Europe, where they will attend 
the meetings of the International Medical Con- 
gress at Budapest in September. After visiting 
Switzerland and France they will return home 
about October l. 1909. 



Doctor Frank Martin, who is travelling in Eu- 
rope, expects tn return to his home the early part 
of < October. 



Doctor Frank Lynn, class of 1907, will sail for 
Europe during the latter part of September, where 
he will devote his time to pathological and sur- 
gical investigation. 



Doctor M. -L McKhmon, class of 1853, a ven- 
erable and prominent physician of York. Penn- 
sylvania, besides one of the oldest living alumni 
of the University of Maryland, is critically ill at 
his home in York. 



The following of our alumni are members of 
the Board of Trustees of the Medical and Chirur- 
gical Faculty of Maryland : 

S. C. Chew. 

.1. W. Humrichouse. 

L. McLane Tiffany. 

Wilmer Brinton. 

(J. Lane Taneyhill, Sr. 

I). E. St, 



retary and treasurer of the Maryland State Board 
of Medical Examiners, has made public the names 
of those candidates who were successful in the 
June examination. Those of our alumni who 
passed : 

Clarence I. Benson. 

X. I. Broadwater. 

William S. Campbell. 

Clarence B. Collins. 

Arthur L. Fehsenfeldt. 

Harry B. Gantt, Jr. 

Richard II. Gantt. 

Joseph W. Hooper. 

Joseph I. Lender. 

I low anl Kerns. 

Samuel II. Long. 

James B. Magraw. 

William E. Martin. 

John J. McGarrell. 

James B. Parramore. 

Samuel .1. Price. 

Wilmer II. Priest. 

William G. Queen. 

Harry A. Hut ledge. 

I (ceil A. Shankwiler. 

Claude ( '. Smitlk. 

Maurice I. Stein. 

Charles F. Strosnider. 

Alfred C. Trull. 

Frederick C. Warring. 



Doctor J. McPherson Scott, of Hagerstown, sec- 



The following of our alumni have been presi- 
dent of the Medical and ( 'hii urgical Faculty: 
Doctors — 

Fnnalls Martin, class of 1818. 
Robert Moore, class of 1819. 
Robert Goldsborough, class of 1820. 
Maxwell McDowell, class of 1818. 
Joel Hopkins, class of 1815. 
Richard Sprigg Steuart, class of 1822. 
Peregrine Wroth, class of 1841. 
William W. Handy, class of 1819. 
Michael S. Baer, class of 1818. 
John L. Yates, class of 1822. 
John Fornerden, class of 1823. 
Joshua I. Cohen, class of 1823. 
George C. M. Roberts, class of 1826. 
Nathan K. Smith, Professor of Surgery. 
Charles II. Ohr, class of 1834. 
Henry M. Wilson, class of 1850. 
John M. Monmonier, class of 1834. 
Christopher Johnston, class of 1844. 



THE HOSPITAL BULLETIN 



159 



Samuel P. Smith, class of 1817. 

Samuel C. Chew, class of 1858. 

H. P. C. Wilson, class of 1851. 

Frank Donaldson, class of 1846. 

Richard MeSherry, class of 1880. 

Thomas S. Latimer, class of 1861. 

George W. Miltenberger, class of 1840. 

I. Edmondson Atkinson, class of 1865. 

John Morris, class of 1826. 

Thomas A. Ashhy, class of 1873. 

L. McLane Tiffany, class of 1868. 

George 11. Rohe, class of 1873. 

J. Edwin Michael, class of is;;;. 

Samuel Theobald, class of 1867. 

William T. Howard, Professor of Gynecology. 

Eugene F. Cordell, class of 1868. 

Samuel T. F.'irlc, Jr., 1870. 

Hiram W Is, class of 1882. 

Charles O'Donovan, class of 1882. 
G. Milton Linthicum, through St. John's 
College. 



The Bulletin wishes him success and many 
honors. 



Doctor Preston Hundley, class of 1909, of Bock- 
ley, West Virginia, was successful before the West 
Virginia Board of Medical Examiners. As far 
as I could find out Doctor Hundley was the only 
graduate from our school participating in the ex- 
amination. 



Dr. Samuel Theobald, class of 1867, has been 
elected president of the American ( )phthalmologi- 
cal Society. He is the first president of this so- 
ciety from the South. Dr. Theobald is a dis- 
tinguished oculist in this city. 



Dr. N. W. Hershnei", class of 1906, recently 
moved from Stewartstown, Pa., to Mechanics- 
burg. He has succeeded well in his profession. 



Dr. R. W. Fisher, former assistant Resident 
Physician to the University Hospital, is now 
practicing his profession with distinguished suc- 
cess in Morgantown, W. Va. Dr. Fisher writes 
to The Bulletin that he finds The Bulletin 
very interesting reading, and always enjoys read- 
ing the same, as it keeps one informed as to the 
whereabouts of old friends and classmates and of 
their progress. 

Dr. Fisher has recently been elected President 
of the Monongalia County Medical Association 
of West Virginia. 



Dr. Fdvvard V. Copeland of Round Hill, 
Ya., who graduated from the medical department 
of the University of Maryland in 1905, sailed 
from New York for Europe on September 11, and 
will take post-graduate courses in London and 
Vienna. 



Dr. J. Julius Richardson, class of 1889, of 
Washington, D. C, is accompanying President 
Taft upon his Western trip as medical adviser. 



Drs. W. J. Blake of Benwood. Simon W. Hill of 
Switchback, Preston Hundley of Berkeley, all of 
the class of 1909, have successfully passed the 
Board of Medical Examiners of West Virginia. 



Drs. 11. O. Keik, J. X. Reik. W. T. Watson, 
J S. Fulton and T. C. Worthington attended the 
international Congress of Medicine at Budapest. 



Dr. John S. Fulton, Professor of State Medi- 
cine, has been appointed executive secretary of 
the International Congress on Hygiene. 



Dr. W. II. Houston was chairman of the 
Dorchester Count}- Republican Convention, held 
on August 31, 1909. 

Among the delegates to the recent Republican 
State Convention were Drs. G. T. Simonson of 
Somerset county, W. H. Houston of Dorchester 
county, Luther Kemp and S. L. Bare of Carroll 
oourltv, and H. B. Gantt of Anne Arundel county. 



Drs. A. L. Wilkinson, Josiah S. Bowc>i, George 
II. Hocking and R. C. Massenburg delivered 
short addresses at the September meeting of the 
Baltimore County Medical Society, held in the 
rooms of the County Board of Health. 



Dr. W. Cuthbert Lyon, class of 1907, of For- 
rest Park, Md., was a successful candidate at the 
recent examination held at Fort McHenry for 
appointment as army surgeon, with rank of first 
lieutenant in the Medical Reserve Corps. Dr. 
Lyon is a native of Newburgh, N.Y., and a gradu- 
ate of the medical department of the University 
of Maryland. Dr. Lyon, after having served a 
year as interne at the University Hospital, went 



i6o 



THE H< ISPITAL BULLETIN 



abroad, where he pursued a course of advance 
study in Germany. The Bulletik extends to 
Dr. Lyon its warmest congratulations and wishes 
him much success. 



Dr. T. B. O wings, class of 1852, the president 
of the Howard County Medical Society, presided 
at the regular September monthly meeting, held 
at Ellicott City, Md., September 6, 1909. Dr. 
Owings is a prominent practitioner of Ellicott 
City and the surrounding country. He has been 
engaged in the practice of his profession for more 
than fifty-five years, and is one of the best known 
physicians in that section of the country. Dr. 
Frank O. Miller, class of 1902, and John W. 
Hebb, Jr., class of 1901, also attended the 
meeting. 



Dr. C. D. Marchant. class of 1897, read a paper 
before the meeting of the Tidewater Medical 
Society, held in Fredericksburg. September 19, 
1909. 



Dr. C. W. Vogel, past assistant surgeon, 
United States Public Health and Marine Hospital 
Service, was granted three days' leave of absence 
from August 23, 1909, under paragraph 189, 
Service Regulations. 



Dr. A. M. Shipley delivered a. lecture to the 
Caroline Medical Society at Denton. September 
9, 1909, on "Abdominal Diagnosis." 



Dr. A. D. McConachie. 805 North Charles 
street, has been elected professor of the Diseases 
of the Ear, Nose and Throat, in the Maryland 
Medical College. Dr. Josiah S. Bowen has been 
appointed an associate to the chair of Diseases 
of the Ear, Nose and Throat in the Maryland 
Collesre. 



Dr. VV. S. Love. 836 West North avenue, has 
been made professor of Therapeutics in the 
Maryland Medical College. 



Dr. Jose Uirsh was in charge of the Hebrew 
Hospital baby camp, which has been closed for 
the winter. 

J. Lee McComas. M. D., one of the oldest 
members of the historic McComas family and 
former assistant surgeon in the United States 
Army, spent September 12, 1900, at the Eutaw 



House. Dr. McComas was born in Baltimore 
May 24, 1835. His family is closely related to 
Henry McComas, who was shot and killed at the 
Battle of North Point. 

The doctor retired from active practice in 1902. 
when he fell and fractured his hip. 

Dr. McComas has had a varied career since 
being graduated from the University of Maryland 
in 1858. He started to practice medicine at 
Berkeley Springs, W. Ya., and in a short time 
went to Oakland, Md. For many years he has 
been the house physician at Deer Park Hotel. In 
1 861 he was appointed an assistant Army surgeon 
and had charge of the Government hospital at 
Oakland. 

Dr. McComas was the attending physician at 
the bedside of Jefferson Davis when he was a 
United States Senator. He also attended Harri- 
son when he was in the L T nited States Senate, and 
is the proud possessor of a cup and saucer 
donated to him by Mrs. Harrison, with the name 
Caroline H. Harrison engraved on it. 

Dr. McComas has traveled extensively, and 
usually resides in Mexico in the winter. He 
speaks several languages. His son. Dr. Henry 
W. AlcComas, of Oakland, took up his father's 
practice at his retirement. For many years Dr. 
McComas, senior, was a surgeon of the Baltimore 
and Ohio Railroad. 



Since returning from his sojourn at Hot 
Springs, Va., the health of Dr. Charles A. Wells, 
Democratic candidate for the State Senate from 
Prince George's county, has improved to such 
an extent that all doubt concerning his acceptance 
of the nomination has been removed. Dr. Wells 
said he would accept October 1. at which time 
he will define his position on some of the leading 
issues of the campaign. 

When seen at his home in Hyattsville Dr. 
Wells said he proposed to prosecute a vigorous 
campaign from early in October until election 
day. 



Under the caption of Leading Men of Maryland 
the Star has this to say concerning Dr. Frank 
Martin, Clinical Professor of Surgery, University 
of Maryland: "Dr. Martin is one of the best 
known practitioners in the city, and stands among 
the prominent medical men of the country. He 
is prominent socially and is a member of the 
leading clubs." Above the preceding inscription 



THE HOSPITAL BULLETIN 



161 



is a portrait of Dr. Martin. By honoring Dr. 
Martin the Star confers a signal honor upon the 
University of Maryland, and the The Bulletin 
is glad that the professors of our institution are 
held in such high repute by the daily papers and 
the people at large. 



Dr. D. C. Absher writes Dr. Randolph Wins- 
low: "I am enclosing a clipping from a July issue 
of our local paper and it will tell you the esteem 
in which the University of Maryland is held in 
this part of the country. I want to see the Uni- 
versity of Maryland prosper and become a real 
State university, and a great one, too, and I hope 
that some day I may be able to help it do so. I 
am assistant in a small hospital here. Xorth 
Wilkesboro, X. C. The notice is as follows : 
"Dr. D. C. Absher was in town this week and has 
decided to locate here (North Wilkesboro, N. C.) 
for the practice of medicine and will return next 
week. Dr. Absher has just completed a thorough 
course at the University of Maryland, one of the 
highest institutions of the country, and received 
license to practice from the State Board recently 
at Asheville. It is a pleasure to have Dr. Absher 
locate here, which is his old home town and 
among his friends, with a promising future." 



Dr. Julian Mason Gillespie, class of 1909, of 
Virginia, has successfully met the entrance 
requirements of the Army Medical Examining 
Board, and has been ordered to report at the 
Army Medical School, Washington, for instruc- 
tion. 



Dr. W. Cole Davis, class of 1908, formerly 
resident physician at St. Joseph's Hospital, Balti- 
more, has successfully passed the Army Medical 
Examining Board, and has been commissioned a 
second lieutenant in the Medical Corps, United 
States Army. He has been ordered to report at 
the Army Medical School, Washington, District 
of Columbia. 



Dr. Joseph Gichner is being congratulated upon 
the birth of a brand-new baby. 



Dr. Felix Jenkins, class of 1849, 84 years of 
age, one of our oldest alumni and for more than 
fifty years a practitioner of medicine in Baltimore, 
is seriously ill at the home of his daughter, Mrs. 
Thomas W. Offutt, near Towson, Md. Dr. 



Jenkins is one of the oldest living representatives 
of his family. He fell upon the pavement on 
Cathedral street in 1907. in front of the Cathedral, 
and broke his hip. Since that time he has been 
in failing" health, and several weeks ago, owing 
to general debility, was compelled to seek his bed. 
Small chances for his recovery are entertained. 
Dr. Jenkins retired from active practice about six 
years ago, since which he has been taking life 
quietly. 



Dr. Eitz Randolph Winslow, class of 1906, has 
returned from Hinton, Va., where he has been 
engaged for the past nine months in the practice 
of his profession, and has located at 1900 Mt. 
Royal Teirace, his former residence. 



Dr. and Mrs. Frank Martin have returned from 
a tour of Europe. They were abroad several 

mi mtlis. 



Dr. William T. Watson, of Baltimore, has 
returned from a four months' trip abroad. 



( )ur alumni took a prominent part in the trans- 
actions of the semi-annual meeting of the Medical 
and Chirurgical Faculty, held at Braddock 
Heights September 15, 16 and 17. Dr. Randolph 
Winslow read a paper entitled "The Surgery of 
the Thyroid Gland"'; Dr. X. M. Owensby, "The 
Almshouse Care of the Insane," and Dr. J. J. 
Carroll, "Why Does ' )pthalmia Neonatorum Con- 
tinue to Cause So Much Blindness?" 

Dr. Nathan Gorter, class of 1870. made .1 
report on the Pure Food Act. Dr. T. Clyde 
Routson, class of 1899, president of the Frederick 
County Medical Association, with a few well- 
chosen words welcomed the visitors on behalf of 
his local society, emphasizing particularly the 
honor which the Frederick Medical Society 
esteemed it to be the hosts of the Faculty. 

Those who attended the semi-annual meeting 
of the Medical and Chirurgical Faculty: 

Baltimore — Drs. C. U. Smith, James J. Carroll, 
X. M. Owensby, Herbert Harlan, Randolph 
Winslow, Samuel T. Earle. John T. King. 

Westminster — Drs. Charles R. Foutz, H. M. 
Fitzhugh. 

Hagerstown — Drs. E. A. Wareham, J. W. 
Humrickhouse, W. D. Campbell, E. L. Bowlus. 

Montgomery County — Drs. J. E. Deets, W. L. 
Lewis, T. E. Darby, E. C. Etchison. 



1 62 



THE HOSPITAL BULLETIN 



Crisfield — Dr. J. J. Somers. 

Pikesville — Dr. H. Lewis Naylor. 

Bryantown — Dr. L. C. Carrico. 

Those who attended were treated to first-rate 
scientific contributions. The social side of the 
meeting was not neglected, there being several 
entertainments, but owing to the unsettled 
weather the proposed side trip to Antietam battle- 
field was fores:one. 



Dr. John Evans Mackall, class of 1908, of 
Elkton, Md., a former assistant resident gynecol- 
ogist at the University Hospital, has received an 
appointment in the Rocky Mount Hospital, N. C , 
of the Atlantic Coast Line Railway. 



Dr. Arthur Ralph Hunter, class of 1903, of 
South Carolina, has been presented by his wife, 
who was Miss Martha Cook, a former pupil nurse 
in the University Hospital, with a bouncing boy. 
This is Dr. and Mrs. Hunter's second child, the 
first also being a boy. 



Dr. James M. Craighill, Clinical Professor of 
Medicine, has been elected chairman of the Sec- 
tion on Clinical Medicine and Surgery, Baltimore 
City Medical Society. 



DEATHS 



Dr. Francis Marion Slemons, class of i860, 
for many years one of the foremost citizens of 
Wicomico county, died September 22, 1909, at 
the home of his son, Dr. Morris Slemons, in Bal- 
timore. Dr. Slemons has been for 49 years a prac- 
ticing physician of Salisbury, Md., and was one 
of the leading medical men in his section of the 
State. He was loved by the people for his many 
fine qualities, and he will be missed in Salisbury 
as perhaps no other man would. Dr. Slemons 
vas born at Fruitland, then Forktown, in 1839. 
The house in which this event occurred is still 
standing. He studied medicine in the medical 
department of the University of Maryland, and 
was graduated from that institution in i860. 
After receiving his diploma, he practiced medicine 
in Fruitland for a number of years, then removed 
to Salisbury, and formed a partnership witli the 
hte Dr. Stephen P. Dennis. 

Since early summer Dr. Slemons has been in 
tailing health ; at that time lie was stricken with 



paralysis, and with his wife, who is also a para- 
lytic, was taken to Baltimore, June t, 1909, to the 
home of his son, Dr. Morris Slemons. a graduate 
of the Johns Hopkins Medical School. 

He gradually became weaker after his removal 
to Baltimore, and died without ever having ral- 
lied. Dr. Slemons was nominated for clerk of 
the Circuit Court by the Democrats in 1885, after 
tne memorable fight in the convention between 
the late Stephen P. Toadvine and Lafayette Hum- 
phreys. He was not a candidate, but was offered 
the nomination and accepted. He was elected, and 
filled the office creditably for six years. He was 
at the time of his death president of the Salisbury 
Building, Loan and Banking Association, which 
organization he helped, to form in company with 
the late William B. Tilghman and Ebenezer L. 
Wailes. Dr. Slemons was a ruling elder in the 
Wicomico Presbyterian Church. He leaves a 
widow and two sons, Dr. Morris Slemons of Bal- 
timore and John Slemons of New York. 



Dr. William S. Cockrell, class of 1879, died at 
his home near Harper's Ferry, W. Ya., August 
27, 1909, in the 66th year of his age. 

Dr. Ernest E. Adelsburger, class of 1902, 30 
vears of age, of 414 N. Carrollton avenue, died 
Friday, September 17, 1909, at his home. 

Dr. Adelsburger was a graduate of the Uni- 
versity of Maryland, class of 1902, and has been 
practicing medicine since that time in Baltimore. 
He is survived bv four brothers and three sisters. 



Dr. James A. Shackelford, class of 1873, of 
Greenville, Miss., died July 19, 1900, at Carroll- 
ton, Miss. 



Dr. Richard B. C. Lamb, class of 1904, of 
Yslita, Texas, died in the Providence Hospital, 
El Paso, Texas, June 22, 1909, of typhoid fever, 
ased 26. 



Dr. John Woolf Burton, class of 1865, com- 
mitted suicide by hanging at his home in High 
Point, N. C, June 30, 1909, aged 65. 



Dr. Byron Clarke, class of 1 88 1, died at Wash- 
ington, Pa., August 5, 1909, of diabetes, aged 72. 
He was formerly professor of X-ray medicine in 
the New York Eclectic Medical College. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 
PRICE $1.00 PER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. V 



BALTIMORE, MD., NOVEMBER 15, 1909. 



No. 9 



BALTIMORE AS AN EDUCATIONAL 

CENTER. 

By T. A. Ashby, M.D. 

The Bostonians claim that Boston is the "hub 
of the universe" and the "Athens of America." 
This claim is based upon the culture, refinement 
and high standard of citizenship of the people of 
that city. However just the claim may be, it is 
a well-known fact that Boston stands among the 
leading cities of this country as a leader in all 
educational enterprises and civic exploits. As a 
home of the largest and most richly endowed 
university in this country, with magnificent hos- 
pitals and charitable institutions, with large pub- 
lic and private libraries and art galleries, with 
enterprising publishing houses, Boston undoubt- 
edly possesses every establishment for the pro- 
motion of education and culture among her peo- 
ple. Her poets, historians, essayists, scientists 
and statesmen have taken rank among the leaders 
of thought and investigation in America. The 
people of Boston, therefore, have a right to take 
just pride in the high standard of culture which 
prevails in that community. When we consider 
the means by which these results have been 
reached it will be found that the people of Boston 
and of Massachusetts have been most liberal in 
their contribution to the endowment of their edu- 
cational institutions and to the promotion of the 
best results which can be achieved by the liberal 
expenditure of money on education, charity, art 
and science. 

Harvard University is a lasting monument to 
the liberality of the people of Massachusetts, 
whilst the splendid hospitals and charitable insti- 
tutions in Boston bear testimony to the liberality 
of that city and State. Two factors have con- 
tributed to the claim which Boston makes as the 
"Athens of America" — first, her liberal expendi- 
ture of money upon her educational institutions, 
and, second, the industry, talent and enterprise 
of her people in fostering literary and scientific 
pursuit. 

Comparisons are usually odious, but it is but 



just in making claims to consider conditions and 
environments. The advantages which Boston 
possessed in the past may be traced to conditions 
rather than environments. Certainly her location, 
climate and soil are not equal to those possessed 
by other communities. Ller poverty in this di- 
rection has no doubt acted as a stimulus in pro- 
moting enterprises which have had less encour- 
agement in more richly favored sections. Athens 
was only a small Grecian city, yet her contribution 
to art and literature is a marvel of the ancient 
world. It would seem that the genius of a people 
has reached its highest state of development under 
conditions where encouragement has been given 
by wealth and civic pride. 

Institutions of learning must be subsidized by 
city, State or private benevolences, as they are 
less able to bear the struggle of poverty of all 
human establishments. To reach the highest 
standard of excellence and the largest develop- 
ment in research and instruction the best teachers 
and investigators are demanded, and all facilities 
for research must be supplied. Endowment or 
subsidy alone can give the equipment needed for 
the highest training of student bodies. The cost 
of education is constantly increasing, and tuition 
fees can no longer meet the requirements of our 
best educational institutions. The city, State and 
private aid must come to the relief of the 
teacher and scientific investigator if the best 
results are to be reached. This has been the 
secret of Boston's intellectual and educational 
supremacy. The people have liberally showered 
their wealth upon her institutions which seek to 
promote education, to relieve suffering and to 
elevate the standard of citizenship. The question 
now arises, Is it not time for the people of Balti- 
more to arouse to the importance of making this 
city the greatest educational center in this coun- 
try? The location of this city in close proximity 
to the nation's capital, her genial climate, the so- 
cial and liberal character of her people, all tend 
to show that Baltimore has all of the material 
advantages of a great center of learning. She 



1 64 



TIE HOSPITAL BULLETIN 



has educational institutions which, if properly 
encouraged, would provide facilities for the edu- 
cation of the largest bodies of students assembled 
from all sections of our country and from all 
parts of the civilized world. As far as can be 
ascertained. Baltimore is drawing annually to her 
educational institutions some 2500 students from 
wide sections of this country. Of this number 
over 1500 are drawn by our medical institutions. 
These students come from all States in the United 
States and from many foreign countries. Egypt, 
Assyria, Japan. China. Cuba. Porto Rico, .Mex- 
ico and other foreign countries are represented 
<n these student bodies. 

The Johns Hopkins University, with its splen- 
did record along the lines of scientific research, 
has extended the fame of Baltimore to all parts 
of the civilized world. This institution is destined 
to do a distinct class of work which will always 
reflect credit upon our city as the home of inves- 
tigation and of intellectual and scientific prog- 
ress. In addition to the Hopkins, there are a 
number of schools preparing both men and 
women for the practical duties of life in all the 
professions and avocations. It is to this class of 
institutions that the hand of friendship and of 
plenty should be extended by both city and State, 
since they are engaged in training the student 
along lines of work which make for education, 
culture and the highest citizenship. Education, 
in its broadest sense, is the preparation of the 
student for useful work, for high moral standards 
and for civic virtues. These are the qualities 
which go to make men. and these are the men 
who go to make cities and States. To attract the 
attention of the outside world to Baltimore as a 
center of education her institutions should be lib- 
erally subsidized and encouraged. They all need 
better facilities in the way of an educational plant 
providing laboratories, libraries and classrooms, 
better pay for teachers and instructors. 

"With an upward development of our institu- 
tions it is believed that the present student bodies 
nmv assembled in these various institutions could 
be doubled or quadrupled in the next five or ten 
years. In other words, with our educational in- 
stitutions thoroughly organized and equipped for 
all classes of educational work of the highest 
standard it will be possible to draw to Baltimore 
a student body of some 10.000 students from all 
parts of the world. The presence of such a large 
body of young men and women seeking an edu- 



cation would have a material and moral value to 
this community which cannot be estimated in 
dollars and cents. Such a body of students 
would give to our city such a prestige as would 
soon establish for her the claim of being the 
"Athens of America." Why not try to wrest 
from Boston her honored claim as a leading cen- 
ter of learning in America and establish that 
claim for our own city, which already is so widely 
known as a city of monuments, as a home of art, 
of culture and of refinement? It is not too op- 
timistic to make the claim that what has been 
done in New England for the promotion of the 
best interests of her people in education, charity 
and citizenship can be done in Maryland. All we 
need here is liberality, pride, love of learning and 
the high spirit of endeavor which has charac- 
terized the Xew England people. 

It may he asked. 1 low can the results here indi- 
cated be reached ? The answer to this question 
will suggest both conditions and environments. 
( irant that Baltimore possesses both of these as- 
sets as her working capital, it is only uecessary 
to use this capital in a productive way. Educa- 
tional institutions, whilst, strictly speaking, they 
are not commercial enterprises, are so dependent 
upon administration and enterprise that success 
and usefulness only follow the wise use of these 
two agencies. An institution of learning must 
own a plant suitably adapted to all of its purposes. 
Its assembly-rooms, halls, laboratories and 
grounds must conform to the needs of its student 
body. Its teachers, instructors and demonstrators 
must be selected with due respect to their moral 
and intellectual equipment for the training of the 
individual student and of the student body. Both 
teacher and student must be fired with zeal and 
enthusiasm, and these faculties are only devel- 
oped by co-operation. 

With such a plant and equipment any institu- 
tion of learning will grow, no matter how humble 
its beginning. A student body will follow the 
law of gravitation. It will always seek institu- 
tions of learning which live up to their promises 
and measure up to requirements. What is needed 
to make Baltimore a center of learning is for 
every educational institution in the city to get 
busy, go after the student and give him in train- 
ing an equivalent for his outlay of money ami 
mental work. 

Nothing will draw students to our city faster 
and in larsjer numbers than this character of in- 



THE HOSPITAL BULLETIN 



16= 



tellectual honesty and industry. The education 
of the student must be considered from a com- 
mercial as well as from an ideal standpoint. The 
student is seeking knowledge primarily, and per- 
sonal comfort, pleasure and sentiment as second- 
ary claims. All of his needs enter into the devel- 
opment and training of his mind and character. 
His home life as a student, his associations, his 
ties and his personal comforts all should contrib- 
ute to his mental growth and equipment. They 
should stimulate his pride and industry and en- 
large his views of life and its responsibilities, as 
well as of its promises. Those institutions which 
recognize these various claims of its student body 
and work in harmony with them will receive full 
returns for the services rendered. 

The life of a student in a large city is beset 
with embarrassments and temptations which must 
be met by the influence of the school over the 
mind of the student. This has been done in 
larger cities than Baltimore, which, perhaps, 
offers more ideal conditions as a center of educa- 
tion than any large city in America. 

All of the institutions of learning in Baltimore 
are, with one or two exceptions, self-sustaining. 
In other words, they are dependent upon tuition 
fees for the conduct of their work. 

In this age of large undertakings and of stren- 
uous growth endowment seems absolutely neces- 
sary to the successful work of institutions which 
aim to attract large student bodies or to do a high 
order of work in advanced culture or scientific 
research. Without endowment an institution 
cannot rank among the great schools of the coun- 
try. It cannot employ high-salaried teachers or 
do any extended work in research or original in- 
vestigation. It does not follow, however, that 
such schools cannot do a useful or high order of 
work in lines of secondary education. Such 
schools can train lawyers, clergymen, teachers, 
engineers and physicians for practical and suc- 
cessful work in their respective professions. It 
will be recalled that less than 40 years ago the 
men who are now the leaders of thought and 
action in this country were almost to a man edu- 
cated in schools which are now classed as sec- 
ondary and which today are giving courses of 
instruction far in advance of that time. Sec- 
ondary schools have advanced as rapidly as the 
largely endowed universities. They will continue 
to hold a large place in the educational curricu- 
lum. To rise to the front rank endowment is 



essential. This term endowment must be consid- 
ered in a relative sense, since it occupies the same 
relation to education that capital does to rail- 
roads, manufacture or mercantile pursuits. The 
small merchant is as much in evidence as the 
department store, and in his small way is doing 
just as good work. The college, high school and 
private school have just as distinct a place in edu- 
cation as the endowed university. They are just 
as necessary to our social and economic life. 
They have as high, if not as distinguished, a mis- 
sion in the educational world, and should stand 
for all that is best in training mind and character 
for private and civic duty. They will give char- 
acter to communities quite as respectable as the 
larger institution if conducted on principles of 
correct thinking and right doing. With one large 
university liberally endowed, Baltimore has a 
large number of schools of the unendowed class 
which are drawing large classes of students to 
this city. These schools can be made the nucleus 
of her growth as a center of education. They 
possess advantages and possibilities which can be 
enlarge) 1 by the enterprise and broad spirit of 
their governing bodies. They have already done 
much for this city, which is only an indication of 
the larger growth of their student bodies under 
energetic and resolute action. In this determined 
purpose of drawing larger numbers of students 
to this city these schools should demand and re- 
ceive every encouragement and aid possible from 
city, State and private liberality. There should 
be no hesitation in going before the public with 
the claim that generous aid extended to education 
in many forms and for recognized purposes is the 
highest test of civic pride and culture. The edu- 
cational plant of a community is of greater value 
to that community, as a rule, than any other 
agency, not excepting a well-conducted press. 
When the wealth and intelligence of our citizen- 
ship is brought to realize that its culture, refine- 
ment and happiness is more largely promoted 
through the various educational agencies at work 
in their community than through its mercantile, 
manufacturing and commercial interests it will 
extend both financial aid and moral support to 
these agencies. It is, therefore, the first duty of 
every institution of learning in this city to keep 
its work in public view, to stand up for all that is 
best in our civic government, and to seek the aid 
of wealth and friendship in the more rapid 
growth of education and charity in our city. 



1 66 



THE HOSPITAL BULLETIN 



THE PROFESSORS OF SURGERY IN THE 
UNIVERSITY OF MARYLAND. 



By Randolph Winslow, M.D., 
Professor of Surgery, University of Maryland. 



No. 3. — Granville Sharp Pattison, M.D. 

Prof. Granville Sharp Pattison was born near 
Glasgow, Scotland, probably in the year 1792. 
He is supposed to have received his medical edu- 
cation at the University of Glasgow. Early in 
life he was an assistant to Prof. Allan Burns, and 
succeeded him in the chair of anatomy, physiol- 
ogy and surgery at the Andersonian Institution 
of Glasgow. He was a favorite pupil of Profes- 
sor Burns, and fell heir to his anatomical mu- 
seum, as well as to his professorial chair. He 
came to America in the summer of 1819 and 
opened an anatomical school in Philadelphia ; but, 
failing to receive an appointment in the Univer- 
sity of Pennsylvania, and declining the chair of 
anatomy in the Transylvania University of Ken- 
tucky, he was offered the chair of surgery in the 
University of Maryland in 1820, which he ac- 
cepted. He was at that time 28 years of age and 
had made no particular reputation as a surgeon ; 
indeed, his predilections were for anatomy rather 
than for surgery, and, except for the brief period 
in which he remained in the University of Mary- 
land as professor of surgery, his energies during 
the whole of his life were directed to the study 
and teaching of anatomy. He was a handsome 
young man, of a somewhat gay and restless dis- 
position, and of a contentious and quarrelsome 
nature. He remained in the chair of surgery in 
the University of Maryland until 1826, when, 
owing to dissensions in the faculty and to the fact 
that the Legislature had repealed the charter of 
the university and had placed the government in 
the hands of a board of trustees instead of in the 
board of regents, in which it was originally vested, 
he resigned his chair and returned to London, 
where he was made professor of anatomy in the 
University of London. During his connection 
with the University of Maryland he made no 
great reputation as a surgeon, but is said to have 
exercised great influence in the faculty, and it is 
thought that the increase and prosperity of the 
medical school during that period was largely due 
to his energy and counsel. He brought with him 
from Scotland the museum of his master, Allan 
Burns, which he induced the university to pur- 



chase at a cost of $Sooo. This collection of ana- 
tomical and pathological specimens was one of 
the richest and most extensive in the United 
States at that time, and for many years continued 
to be the greatest attraction of the medical school. 
It was said to have numbered 1000 specimens, 
and even to this day some of the most valued and 
valuable attractions of the anatomical department 
were originally a portion of this collection. So 
valuable and so highly esteemed was this museum 
that a special building was erected for its hous- 
ing, which became known subsequently as Prac- 
tice Hall, but after various mutations, alterations 
and rebuilding is now the Gray Laboratory Build- 
ing. Dr. Pattison returned to America in 1832, 
and was elected professor of anatomy in Jeffer- 
son Medical College in Philadelphia, which posi- 
tion he continued to fill until 1841, when he be- 
came professor of general descriptive and surgi- 
cal anatomy in the recently founded medical de- 
partment of the University of New York. He 
continued to occupy this chair until his death on 
November 12, 1851, after a short illness from 
obstruction of the common bile duct. 

Professor Pattison was the author of the "Reg- 
ister and Library of Medical and Chirurgical 
Science." He edited, with notes, "Burns 011 the 
Surgical Anatomy of the Arteries of the Head 
and Neck," Masse's "Anatomical Atlas" and Cru- 
veilhier's "Anatomy." He was one of the editors 
of the American Medical Recorder, and wrote a 
number of articles in the periodicals. He received 
the honorary degree of doctor of medicine late in 
life, and was held in high esteem as a teacher and 
lecturer in this country. He became involved in 
a controversy with Prof. Nathaniel Chapman of 
the University of Pennsylvania, which culminated 
in his sending to Dr. Chapman a challenge for a 
duel, which, however. Professor Chapman de- 
clined to accept, and in consequence of which dis- 
pute a hostile meeting was arranged some years 
later between Gen. Thomas Cadwallader of Phil- 
adelphia, who was Chapman's brother-in-law, 
and Professor Pattison. The duel took place in 
Delaware, and Cadwallader was severely 
wounded, the bullet entering his pistol arm near 
the wrist and lodging in the ulna, where it re- 
mained throughout his life, causing serious disa- 
bility and impairment of health. Pattison es- 
caped without injury by a narrow margin, as the 
bullet passed through the skirt of his coat near 
the waist. 



THE HOSPITAL BULLETIN 



167 



REPORT OF A CASE OF CYST OF BRAIX. 



By F. Rankin, M.D., 
Resident Surgeon University Hospital. 

Owing to the comparative rarity of the condi- 
tion and difficulty of diagnosis, perhaps a report 
of a case of cyst of the brain found in the left 
frontal lobe may be of interest. 

A. P.. white male, age 22 years, lawyer by pro- 
fession, enters hospital July 30. Patient com- 
plains of a chain of symptoms extending over a 
period of three years, but which within the last 
six months have become so much more marked 
as not only to be noticeable to his associates, but 
to interfere with his work. 

Motor aphasia, the most marked and distress- 
ing symptom of which he complains, has been a 
source of trouble only within the last half year, 
but during this time the patient's family have 
been aware of a decided change in the man's dis- 
position and habits, he having apparently lost in- 
terest in things that formerly were his greatest 
pleasures and becoming gradually less energetic 
recently, showing no desire to do anything re- 
quiring any exertion, and more and more listless 
and inactive. 

One distinctive feature of his condition, how- 
ever, is the fact that he is never irritable nor has 
been known to complain. 

At irregular intervals patient has suffered from 
violent headaches, the pain of which was diffuse 
over entire head, with no tendency to localize in 
any one place. The attacks were not accom- 
panied by nausea or vomiting, but were occasion- 
ally preceded by any attack of vertigo. An ex- 
amination of the eyes by an expert revealed no 
evidence of "choked disc.'' 

PHYSICAL EXAMINATION. 

Patient is small man, weighing 135 pounds and 
standing 5 feet 5 inches in height. Denies any 
loss of weight. Is well developed ; muscle good ; 
skin elastic ; fair amount of subcutaneous fat. 

Expression : Dull, listless, indifferent. 

Eyes : Right pupil larger than left ; reacts to 
light and accommodation, but rather sluggishly. 
Left pupil normal. Vision good in both. No 
"choked disc.'' 

Ears : Low set. 

Teeth : In excellent condition. 

Palate : Arch normal. 



Neck : No pulsations or glandular enlarge- 
ment made out. 

Thorax : Heart and lungs negative. 

Cranial Nerves : Normal. 

.Motor Power : Normal. 

Sensation : Normal, no areas of anesthesia or 
hyperesthesia being found over entire body. 

Co-ordination : Good. 

Patella Reflex : Exaggerated on both sides, 
slightly more so on right than on left. 

Babinslci : Present on right side. 

Gordon Reflex: Present on right side. 

Tendo Achilles Reflex : Slightly exaggerated 
on both sides, more so on right than on left. 

Ankle Clonus: Present on both sides. 

Abdominal Reflexes : Normal. 

Mentality: Good. 

Appetite : Good. 

Bowels move regularly once a day. 

No urinary or gastrointestinal symptoms. 

Urinary Analysis : Color, straw : reactions, al- 
kaline : sugar, negative ; albumin, negative ; spe- 
cific gravity, 1015: sediment, scant: triple phos- 
phates, amorphous phosphates, occasional hya- 
line cast, few leucocytes and epithelial cells. 

BLOOD. 

Leucocyte Count : 14,000. 

Red-Cell Count: 6,488,000. 

Hby. Count : 100 per cent. 

Temperature: 98 . 

Pulse: 68: full, strong, good volume and ten- 
sion ; equal on both sides. 

Family History : Negative. 

Past History : At age of eight years patient 
suffered from an attack of acute articular rheu- 
matism, which was recovered from in short time 
and was followed by 110 sequelae. Two years 
later, however, he developed Eydenhaur's chorea, 
which persisted for about six months and then 
cleared up, leaving the patient in good condition 
and without complications. 

Specific History : Admits to gonorrhea six 
years ago, but since has felt no ill-effects. Nega- 
tive to syphilis. 

Habits : For past eight years patient has been 
a hard drinker and has lived a more or less disso- 
lute life. Recently he claims to have given up the 
use of alcohol in any form. Is also an inveterate 
user of tobacco, using it mostly in cigarette form. 
Does not use coffee or tea. 

Diagnosis : After careful examination of the 



[68 



THE HOSPITAL BULLETIN 



patient, as set forth above, the diagnosis of intra- 
cranial growth of the left frontal lobe was made 
for the following reasons : The gradual change 
of character ; the presence of speech disturbances 
and the presence of irregular, periodic, mo- 
mentary attacks of unconsciousness ; the tripillary 
quality : the irregular, violent attacks of head- 
ache ; the more marked increase of the deep re- 
flexes on the right side; Babinski and Gordon 
reflexes on the right side, with their absence on 
the left, and the general appearance of the pa- 
tient. 

Having decided upon the diagnosis of intra- 
cranial growth, a craniotomy was advised, ac- 
cepted, and the operation performed August 5. 

Operation : Craniotomy. 

Operator : Dr. Shipley. 

Assistant : Dr. Rankin. 

Anesthetist : Dr. Broadwater. 

Anesthetic : Ether, drop method. 

The head having been prepared in the usual 
manner for an aseptic operation, a curved in- 
cision about six inches in length and having its 
concavity downward was made over temporal 
fossa on left side, the incision beginning an inch 
behind external angle of left eye and ending di- 
rectly over ear. Having cut through and dis- 
sected away the fascial and tissues covering the 
temporal muscle, the fibers of this muscle were 
exposed and separated, the periosteum of the 
skull raised and the skull trephined with the Hud- 
son trephine. 

Immediately upon the removal of a button of 
bone the brain was found to be under great ten- 
sion, the dura bulging perceptibly and the pulsa- 
tion being more indistinct than normal. The dura 
was incised, and the brain found to be anemic, 
slightly edematous in appearance, but pulsating. 
The second left frontal convolution was punc- 
tured, and about 2 ounces of a clear fluid flowed 
out of the opening. A definite cavity and wall 
could be made out by introducing a probe into the 
punctured convolution. Llaving drained out all 
the fluid and stopped a rather troublesome oozing 
from the bone with Horsley's wax, the dura was 
closed, as were the other layers, muscle, fascia 
and skin, in order in usual manner. 

Patient recovered from the operation with very 
little reaction, and on the fifth day was allowed 
to be up in rolling chair. On eighth day stitches 
were removed, and wound found to have healed 



by primary intention, approximations being ex- 
cellent and scar only slightly noticeable. 

The operation having been subtemporal, and 
the fibers of the muscles separated and not cut, 
there was no depression. 

On fifteenth day patient's symptoms had cleared 
up remarkably, and he feels entirely well. 

Examination : Expression good. Gordon re- 
flex present on both sides, Babinski absent on 
right side. 

Patella Reflex : Slightly exaggerated on both 
sides. 

Abdominal Reflexes : Normal. 

Co-ordination : Good. 

Sensation : Normal. 

Cranial Nerves : Normal. 

Eyes : Pupils equal and react normally to 
sight and accommodation. 

Motor aphasia has cleared up entirely. 

Patient discharged in greatly improved condi- 
tion and, in his own words, "feeling like a dif- 
ferent man." 



THE USE OF IODINE AS AN ANTISEP- 
TIC IN SURGICAL AND GYNE- 
COLOGICAL PRACTICE. 



By I. S. Stone, M.D., Washington, D. C. 

For some years past (January, 1872) we have 
been using solutions of iodine in our gynecologi- 
cal work and to the exclusion of nearly all other 
so-called antiseptics. Iodine may be relied upon 
as an antiseptic, disinfectant and deodorizer in 
every variety of gynecological work. That is to 
say. it will accomplish anything expected of the 
other agents of this class without the evil, toxic 
or undesirable results often observed when anti- 
septics are used. In the hospital where the 
greater part of my surgical work is done the odor 
of iodoform is rarely observed, my colleague and 
I having voluntarily relinquished its use many 
years since, at about the same time, but inde- 
pendently of each other. Since then we notice 
the use of iodoform only when some younger 
surgeon thinks it necessary. My vaginal hys- 
terectomies, or Wertheim operations, all recover 
without iodoform as well as they ever did with it. 
In fact, we can conceive of no necessity for any 
antiseptic upon gauze in clean abdominal or vagi- 
nal work. There are, however, occasions when 
there is need for thorough cleansing of the uterus. 



THE HOSPITAL BULLETIN 



169 



or possibly an abscess cavity where one wishes to 
add an antiseptic to the gauze pack or drain. It 
is in such cases that iodine is quite as satisfac- 
tory as any other agent. It is nearly non-toxic 
and rivals permanganate of potash in its antisep- 
tic qualities. Our constant use of iodine as an 
antiseptic dates from the time of Senn's adoption 
of the Claudius method of sterilizing catgut. We 
think this catgut has been found as germ-free as 
any other, and hence our adoption of the drug as 
a bactericide. Iodine has been found capable 
of better penetration of catgut than any other 
chemical agent. This fact should favor its use in 
many instances where there is a demand for an 
agent which will penetrate into the tissues with- 
out destructive action. 

The agents which are in constant use in our 
hospitals, such as hydrogen peroxide, mercuric 
bichloride and acid carbolic, have a destructive 
action upon healthy tissues, and wound healing is 
retarded by their use. Besides their toxic effect, 
they coagulate albumen and produce a necrosis 
which must be removed or repaired before such 
wounds can unite. We therefore use and recom- 
mend the use of iodine solutions somewhat as 
follows : 

1. In the vagina and uterine cavity for acute 
vaginitis and endometritis, or when we believe 

tthe mucosa invaded by infection without ocular 
evidence of inflammatory changes. 

2. When the uterus requires curettement for 
any purpose whatever, as for missed abortion, 
small fibroid or mucous polypi, or in sapremia, or 
hemorrhagic endometritis. The gauze packing is 
saturated with the iodine solution just prior to 
its use. 

3. To any stump left in the abdomen con- 
nected with the vagina, uterus or bowel, such as 
occurs after supravaginal hysterectomy, or ap- 
pendectomy, excision of diverticula;, etc., where 
carbolic acid or similar agents have formerly 
been used. We now apply iodine (25 per cent.) 
to the cervix and portio before hysterectomy for 
tumor. This usually leaves a sterile area through 
which the uterus is amputated. 

4. In any abscess cavity if gauze is needed, as 
in mammary abscess or in case of hemorrhage 
after incision requiring gauze packing. 

5. On the abdomen or upon any skin surface 
5 to 10 minutes before making the incision. 

Recently we read in a German medical journal 
that a surgeon was relying upon this method to 



the exclusion of all other sterilization of the skin, 
including the preliminary scrubbing with soap 
and water. We follow the method outlined be- 
low mainly in a class of cases requiring prompt, 
quick -work without prolonged anesthesia. The 
patient is as carefully prepared in her room and 
bed as may be done by the ward nurse. This in- 
cludes plenty of green soap and water and gauze 
scrubbing. A towel is pinned around the patient 
to prevent contact with hands, clothes, etc. After 
arriving in the anesthesia-room the abdomen is 
painted with 25 per cent, iodine tincture. U. S. P., 
or equivalent of compound tincture. The paint- 
ing is usually done before the patient takes the 
anesthetic, as this leaves nothing to be done but 
catheterization (if required) before placing the 
patient upon the operating table. The usual ex- 
posure of the abdomen and wetting of the frail 
patient is to be avoided if one can do so without 
danger of infection. We believe iodine is capable 
of sterilizing the skin as well or even better than 
any other chemical agent, and it enables us to add 
this important matter of technique, namely, the 
dry skin instead of a wet one, the desirability of 
which should be apparent to everyone. As I 
write this I have received a letter from a friend 
in Mount Sinai Hospital in New York describing 
practically the same method as the above. At 
that hospital the iodine is applied the night before 
operation, and a second application is made when 
the patient is placed upon the operating table. 
Stoneleigh Court. Washington. D. C. 



THE ETIOLOGY OF PERITONITIS. 



By F. P. Firer, 
Senior Medical Student, University of Maryland. 

In considering the etiology of peritonitis, bac- 
teria and their products are of paramount impor- 
tance, and the sources of infection come, almost 
without exception, from the outside, either 
through the walls of the cavity or some one of 
the intra- or extra-abdominal viscera. 

Rare affections, as found secondary to acute 
rheumatism of joints and nephritis, are probably 
hematogenous inflammation of the appendix, and 
bile passages, ulcerations and perforations of the 
gastrointestinal tract, infection through the Fal- 
lopian tubes, thrombosis of any portion of the in- 
testinal tract secondary to mechanical disturb- 
ances, rupture of abscesses of any r of the organs 



I/O 



THE HOSPITAL BULLETIN 



in relation to the peritoneum are among the usual 
sources of peritonitis. The so-called aseptic peri- 
tonitis caused hy foreign bodies, sponge ligatures, 
hemorrhage due to trauma, ectopic gestation, 
outpour of fluid from a ruptured gall-bladder, 
kidney, cysts of various forms is most liable to 
become septic by invasion of bacteria. 

The subperitoneal tissue is richly supplied with 
lymphatics and blood vessels, giving rise to the 
hemotogenous variety of peritonitis, the usual 
form being secondary to pneumonia, tuberculosis 
and puerperal invasion. Tuberculosis of the peri- 
toneum is- seldom primary, usually resulting from 
some distant foci, as tuberculosis of the mesen- 
teric or retroperitoneal glands, tubes and ovaries. 

Pseudo-tuberculous peritonitis may be pro- 
duced by bacteria, fungi of different forms, small 
bits of foreign bodies, animal parasites, etc. Per- 
forative peritonitis is the most important and is 
a true polyinfection, as many as 10 different spe- 
cies of bacteria having been found. The bacteria 
most commonly found in peritonitis is the colon 
bacillus, but the streptococcus and staphylococcus 
are the usual forms producing this condition, as 
will be explained later. The pneumococcus, ty- 
phoid bacillus, gonococcus are among the most 
common. Bacillus pyocyaneous is occasionally 
found. As predisposing factors may be men- 
tioned sudden changes of temperature, suppres- 
sion of long-standing discharges, malignant tu- 
mors, cachexia, long persisting pain and discom- 
fort, secondary mental and nervous phenomena 
or any condition having a tendency to lower re- 
sistance. 

The acute and chronic forms of peritonitis are 
to be differentiated, which may be general or 
localized. The acute localized peritonitis is seen 
in cases in which bacteria escapes gradually and 
in small numbers through the walls of the viscera 
or in which perforation takes place after the pro- 
duction of some exudate, which serves the pur- 
pose of limiting the extension of the infection. 
This form may often be seen associated with dis- 
eases of the tubes or uterus and in the region of 
the appendix. Acute general peritonitis may be 
the immediate result of the discharge of a large 
quantity of infective matter from a perforated 
bowel or other organ, or occur secondarily to 
localized peritonitis when the lining wall of exu- 
dation is broken down. 

The most violent forms of peritonitis may as- 



sume a putrid character and the tissues rapidly 
undergo necrosis. 

Chronic peritonitis may be the termination of 
an acute attack or be chronic from the beginning. 
It may result from chronic inflammation or a 
thickening extending from adjunct organs. Thus 
in cirrhosis of the liver the peritoneum covering 
the spleen may be involved in consequence of the 
chronic congestion or inflammation of this organ. 
Disease of the appendix, uterus, tubes or ovaries 
may be associated with this form of peritonitis. 

Chronic peritonitis may result in replacement 
of the peritoneum by connective tissue, which 
mats all the viscera together. Peritonitis may 
result from undetermined causes, as from syph- 
ilis, gonorrhea, rheumatism. There must be some 
injury to the delicate endothelial cells lining the 
peritoneum before peritonitis will take place. 
Among the conditions not previously mentioned 
may be added the action of chemicals, such as 
mercuric chloride injections, drying or chilling 
of the peritoneal surface, excessive handling of 
the intestines, constant use of stimulating fluids, 
dysentery, strangulated hernia or anything pro- 
ducing intestinal obstruction, stab wounds and 
other conditions too many to be enumerated. 

The following experiment tends to prove that 
peritonitis must be produced by some injury to 
the delicate endothelial cells lining the perito- 
neum : 

The injection of a moderate amount of a cloudy 
culture of bacteria into the peritoneal cavity pro- 
duces no peritonitis, neither does the injection of 
bacteria and their toxins, as both are rapidly ab- 
sorbed by the healthy peritoneum. Feces are es- 
pecially dangerous because the foreign particles 
irritate the peritoneal membrane. They also con- 
tain the bacteria, so that the injured area pro- 
tects them from rapid absorption. When an 
abscess ruptures into the peritoneal cavity it car- 
ries in the discharged pus all of the necessary 
elements for a spreading infection. The bacteria 
and toxins which are hidden in the particles of 
fibrin and necrotic tissue, which acts as an irri- 
tant as well as to harbor the bacteria until an in- 
flammation can be started in the, as yet, unin- 
jured peritoneum. Trauma during the course of 
an operation and the simple presence of bacteria 
will start an active process, and foreign particles 
are not necessary to start an inflammation. 

The discovery of colon bacillus in the perito- 
neal fluid a few hours before or after the death 



THE HOSPITAL BULLETIN 



I7X 



of a patient cannot be assumed as ai. absolute 
evidence concerning the infective organism, as 
one instance is recorded in which one hour after 
death, due to peritonitis as a terminal infection 
of cirrhosis of the liver, a small quantity of the 
exudate was withdrawn by means of a sterile 
syringe and found to contain a pure culture of 
pneumococcus. Twenty-six hours after death 
the cultures obtained from the purulent exudate 
showed only the presence of vast numbers of 
colon bacillus. Hence the difficulty encountered 
in the isolation of a feebly growing pathogenic 
germ in the presence of a more vigorous sapro- 
phyte. 

In appendicitis the organ may be surrounded 
by a pus sac containing nothing but colon bacil- 
lus, but its wall upon section, and properly 
stained, will show throughout its whole thickness 
streptococci. 



EXCESSIVE DIARRHEA IN TYPHOID- 
ITS CONTROL. 



By Nathan Winslow, M.D. 

Different authorities and different teachers 
have various views upon this most perplexing 
question. Some advise, if the stools number no 
more than ten or a dozen, to adopt no measures 
for their control, whilst others suggest the use of 
chalk mixture, opium, bismuth, etc. ; again, still 
others recommend purgation with calomel and 
salts in obstinate diarrhea. It has been my cus- 
tom to keep hands off in the dysenteries of ty- 
phoid, but having recently a case with peristent, 
annoying diarrhea, I spoke to my friend. Dr. Wil- 
liam 1. Messick, and asked him his experience 
with the diarrheas of typhoid. Much to my sur- 
prise, he replied that in an experience of more 
than 14 years he had never had a case of typhoid 
with frequent fecal movements. L^pon recogniz- 
ing that he was dealing with typhoid fever, with 
a tendency to frequent alvine evacuations, he 
placed his patient upon resorcin, grains 5, every 
four hours, and in a very few days the patient 
was constipated. So. heeding his advice, I re- 
sorted to his method of treatment, and within a 
few days the movements were reduced from 10 
to 12 in a clay to one or two. with a great deal of 
relief to the patient both in energy and mental 
anguish. This is a very simple remedy, with no 
danger to the patient. Resorcin controls the 



diarrhea by inhibiting fermentation of the intes- 
tinal contents. 

Realizing that others are as ignorant as I. this 
paper was written with the view of aiding them 
in a like predicament with me. 



INFANTILE lALNDICK. 



By Nathan Winslow, M.D. 

In the newly-born two varieties of jaundice are 
encountered: (1) Physiological; (2) Septic. 

Physiological. — According to statistics, jaundice 
makes its appearance in 33 per cent, of all recently- 
delivered children about the fourth or fifth day of 
their life. After increasing in severity for a day 
or two, it slowly disappears. The duration of the 
average case is three or four days, but at times it 
lasts a week. It shows no preference for either 
sex, one being attacked as frequently as the other. 
It occurs more often in the cases of premature 
birth. The discoloration is first noticed in the 
skin of the face and chest, then in the conjunctiva, 
and finally in the legs and arms. The color of the 
skin varies from a pale to a dark yellow. Idio- 
pathic jaundice is not associated with any rise of 
temperature. The intestines are not affected in 
this form of infantile jaundice. We rarely see 
any difference in the color of the stools. The 
urine is very apt to be normal, but at times it may 
contain bile. 

Its pathology is unknown, but some believe it 
to be hepatogenous in its origin and due to a 
resorption. In consequence of the great changes 
taking place in the circulation of the liver as well 
as in the circulatory fluid itself, there is an en- 
gorgement of the portal circulation which presses 
upon the biliary capillaries and causes a stasis of 
the bile. Owing to this congestion of the portal 
circulation, the great destruction of the red cor- 
puscles taking place in the liver and the stasis in 
the biliary ducts, there is an absorption of bile by 
the blood vessels. This malady is never fatal, 
and requires no treatment. 

Malignant Jaundice. — Occasionally jaundice is 
met as a symptom of an infection, for which rea- 
son it is spoken of as septic or malignant jaundice. 
This condition arises in the greatest number of 
cases from infections taking place through the 
umbilicus ; in fact, 80 per cent, of the infections 
of the newly-born occur through the above-named 
source, but wounds or abrasions of the skin or 



172 



THE HOSPITAL BULLETIN 



mucous membrane, such as those caused by the 
application of forceps, offer also portals of en- 
trance to pathogenic bacteria. 

In cases where the umbilicus is the seat of the 
lesion, the symptoms depend upon the variety and 
virulence of the organism and the physical con- 
dition of the victim. If the invading germ be- 
longs to the staphylococcus group, an omphalitis 
is present, and if the organism is virulent enough, 
local abscesses may make their appearance about 
the seventh or tenth day in the abdominal wall. 
If the exciting cause is the streptococcus, the in- 
fection is much more extensive, and in those cases 
in which the resisting power of the child is low- 
ered or the germs are extraordinary virulent, the 
peritoneum is apt to be involved, whence the or- 
ganisms gain an entrance into the general circu- 
lation, giving rise to a septicemia. The etiological 
factors of septic jaundice are identically the same 
organisms as those found in adult septicemia. 
The jaundice associated with septic infection 
hasn't such an intense hue, but is more persistent 
than that found in idiopathic jaundice. As septic 
jaundice is only a symptom of blood poisoning, we 
will also have all the other signs of septics, such as 
a weak, rapid, corded pulse ; increased, shallow 
respirations ; pinched features ; sunken eyes ; ab- 
dominal distension, tenderness and tympany ; re- 
versed peristalsis of the bowels and fecal vomit- 
ing ; septic temperature. The toxines first stimu- 
late the nervous system, so that the patient is ex- 
ceedingly irritable and restless. As the poison 
increases, however, very rapidly, delirium soon 
gives place to convulsions, stupor or coma. In 
these cases we obtain histories of the umbilical 
wound having been handled with no aseptic pre- 
cautions. 

Winkel's Disease. — Sometimes jaundice appears 
in epidemic form, when it is known as Winkel's 
disease. The essential features of the disease are 
hemoglobinuria, with intense icterus of the skin 
and internal organs. It is a very rare and fatal 
malady, occurring mainly in institutions. It is 
undoubtedly due to some infection, and is sup- 
posed to be caused by a peculiar form of strepto- 
coccus. The symptoms usually begin from the 
fifth to the eighth day after birth. They are in- 
tense and fulminating in character, seldom last- 
ing more than a day or two. The urine is passed 
frequently, in small quantities, and with strangury. 
It is of a brown, smoky color, and under the mi- 
croscope shows the presence of hemoglobin and 



red blood cells, but it does not contain bile. The 
jaundice of the skin is intense, and the patient 
has a brownish hue. All of the cardinal symptoms 
of sepsis, such as a weak, rapid pulse, shallow, 
hurried respirations, prostration, delirium, stupor 
and coma, will be present. 

When due to the staphylococcus, the prognosis 
is good, but in all other instances the case is very 
likely to end fatally. 

The treatment is largely prophylactic. You 
should treat the umbilicus as asepticallv as vou 
would any other wound. In symptomatic iaun- 
dice treatment is of little avail, but alcoholic and 
ammoniacal remedies may be tried. If abscesses 
are present, open them. Keep the child alive with 
stimulants, and apply hot-water bags to the ex- 
tremities. In desperate cases normal salt infusions 
mav be tried. 



THE PART THE UNIVERSITY PLAYED 
IN OPHTHALMOLOGICAL DE- 
VELOPMENT IN 
AMERICA. 

The foundation of the Baltimore Infirmary 
was laid in 1823, and patients were received the 
same year. There were four wards, of which one 
was reserved for eye diseases, instruction in oph- 
thalmic surgery forming a prominent feature in 
the course (Hubbell, The Development of Oph- 
thalmology in America). Be this as it may, we 
can find no authentic record as to who gave the 
course of instruction. He attributes it to George 
Frick, M.D., a prominent ophthalmologist of the 
day, and later professor of natural history. Uni- 
versity of Maryland. 

According to the same authority, George Frick 
was the first in America to undertake to restrict 
his professional work almost exclusively to oph- 
thalmology. He was born in Baltimore in 1703. 
After completing his medical studies and grad- 
uating from the University of Pennsylvania in 
181 5, he was licensed to practice in his native 
city in 1817. He visited Europe, where he be- 
came a favorite pupil of the celebrated Vienna 
ophthalmologist, Beer. He came to feel deeply 
the dearth of knowledge of diseases of the eye in 
America, and set himself to work to so qualify 
himself under the great master that he might 
return to his home and give some enlightenment 
and a scientific uplift to a neglected department 
of medicine. After a prolonged period of study 



THE HOSPITAL BULLETIN 



l /3 



and enthused by Beer as an exclusive specialist, 
he returned to Baltimore in 1818 and undertook 
in a measure to follow his teacher's example. He 
at once began his plans for ophthalmologic work. 
He organized a special eye clinic in connection 
with the Baltimore Dispensary and established 
a course of lectures in the University of Mary- 
land. Having tastes for other pursuits, he was 
led to abandon his profession so well begun. He 
finally repaired to Dresden, where he died in 
1870, at "j" years of age. 

Additional notes upon this subject will appear 
from time to time in the BULLETIN. 



PERSONAL NOTICE. 

Dr. Allen Keer Bond, class of 1885, of Balti- 
more, Md., formerly librarian of the Medical and 
Chirurgical Faculty of Maryland, editor of the 
Maryland Medical Journal and lecturer on dis- 
eases of children and dermatology in the Balti- 
more Medical College, was born March irt, 1859, 
at Kalmia, Harford County, Maryland, on lands 
which were deeded to his ancestors by Lord Balti- 
more in the early time of the colony. He is of 
American and Scotch ancestry, and comes of a 
family of physicians, of some of whom a brief 
mention is opportune. 

His great-grandfather. Dr. Solomon Birckhead, 
was an eminent and highly-esteemed physician, the 
period of whose active life included parts of two 
centuries. He was born at Cambridge, Md., July 
21, 1 76 1 ; graduated in medicine from the Univer- 
sity of Pennsylvania in 1783 ; was treasurer of the 
Medical and Chirurgical Faculty of Maryland 
from 1809 to 181 1 ; consulting physician to Balti- 
more Hospital in 1812, and died in Baltimore 
November 30, 1836. 

Dr. Thomas Emerson Bond, grandfather of Dr. 
Allen Kerr Bond, was born in the city of Balti- 
more in February, 1782, and was one of the most 
distinguished physicians of his time. He grad- 
uated in medicine at the University of Pennsyl- 
vania in 18 19, and also received the degree of 
D.D. He practiced in Baltimore many years, 
and was president of the Medical and Chirurgical 
Society of Baltimore, 1832-33; member of the 
City Council in 1837; president of the City Board 
of Health in 1839 ; president of the board of Trus- 
tees of Baltimore College of Dental Surgery, 1839. 
He also was a local preacher of the Methodist 
Episcopal Church, and his zeal and abilitv pro- 
cured him the title of "Defender of the Church." 



He was editor of the Itinerant, 1830-31, and of the 
Christian Advocate and Journal of New York for 
12 years, 1840-52. Dr. Bond died in New York 
city March 14, 1856. 

Dr. Thomas Emerson Bond, Jr., son of the 
above mentioned and father of Dr. Allen Kerr 
Bond, was born in Harford County, Maryland, 
in November, 1813, and received the M.A. degree 
from Baltimore College in 1830 and the degree of 
M.D. from the University of Maryland in 1824. 
He practiced in Baltimore about 15 years, and in 
1853 returned to his native county, and after- 
wards devoted his attention to literarv and church 
work, for he, too, was a local preacher of the 
Methodist Episcopal Church. In 1839 he helped 
to found the Baltimore College of Dental Surgery, 
and was its professor of special pathology and 
therapeutics from 1839 to 1872, and dean of the 
college from 1842 to 1849. He was a member 
of the City Council in 1847; professor of materia 
medica and hygiene in Washington University, 
Baltimore, from 1842 to 185 1, and in 1867 took a 
prominent part in the work of reorganizing the 
University. 

As an author and editor Dr. Bond enjoyed a 
wide reputation. His first published "work was 
"Treatise on First Dentition" (from the French 
of M. Baumes), New York, 184 1, which was fol- 
lowed by his "Treatise on Dental Medicine," 8 v., 
Philadelphia, 1851-52. He was also author of 
"The Life of John Knox" ; joint editor of The 
Guardian of Health, 1841 ; editor of The Balti- 
more Christian Advocate and the Episcopal Meth- 
odist. Dr. Bond died August 19, 1872. 

Dr. Allen Kerr Bond acquired his earlier liter- 
ary education in Belair Academy, Curtis Academy, 
at Fallston. Md., and George C. Carey's private 
school, in Baltimore, and his higher education at 
the Johns Hopkins University, where he grad- 
uated with the degree of B.A., in 1880. He was 
educated for the profession of Medicine at the 
University of Maryland School of Medicine, 
graduating from that institution as Tiffany prize- 
man, with the degree of M.D., in 1882. In 1882- 
83 he was a resident physician to Bayview Hos- 
pital. In 1885-86 he took special courses in the 
Imperial Hospital at Yienna. Austria. He has, 
since graduating, engaged in the practice of his 
profession as his forbears in Baltimore, and in 
connection therewith has given of his time to 
hospital and editorial work, and also to profes- 
sional attendance at various eleemosvnarv insti- 



174 



THE HOSPITAL BULLETIN 



tutions. In 1884 he was librarian of the Medical 
and Chirurgical Faculty of Maryland, and for five 
years lecturer on diseases of children and der- 
matology in the Baltimore Medical College. For 
some years, also, he was editor of the Maryland 
Medical Journal. 

He became a member of the Medical and 
Chirurgical Faculty in 1888. He was a member 
of the Baltimore Academy of Medicine, the Mary- 
land Public Health Association, the Clinical So- 
ciety of Baltimore and the Baltimore Medical 
and Surgical Association. Dr. Bond has pub- 
lished many clinical and philosophical studies in 
medicine, and also a volume entitled "How Can 
I Cure My Indigestion" { Contempary Publishing 
Co., New York). He married August 2, iqp8, 
Louise Birckhead Gambrall, daughter of the late 
Rev. T. C. Gambrall and Susan B. Gambrall. Fie 
resides at 949 Park avenue, Baltimore. Dr. Bond 
is a friend and admirer of the University, and a 
well-wisher for its success. I le takes pride in its 
advancement and evidence of renewed progres- 
siveness. 



URINARY CALCULUS, WITH 
( >PERATION. 



By R. R. Norris, M.D.. Class of 1907, 
Crisfield. Aid.. 

Former Chief Resident Physician Bayview 
Hospital. 

The case I want to bring to your attention to- 
night is one that came under my observation at 
Bayview when I was chief resident physician of 
the Almshouse Department. When I first came 
on the staff the case was pointed out to me as a 
case of chronic cystitis in an old woman who was 
irritable and hard to manage. She was then being 
irrigated with boracic acid, but did not show much 
improvement. To be brief, 10 days after I saw 
her she was removed from Bayview and taken to 
her son's home in Baltimroe ; she remained there a 
while, and was then taken to the Hopkins Hospi- 
tal, then to the Hebrew Hospital, and after a 
period of about three months she came back to 
Bayview with no improvement. I will now give 
you the historv of the case. 

Mrs. A. G. ; age, 69 ; nationality. Hebrew ; first 
admittance to Bayview, December 1. 1005; dis- 
charged. June 20, 1906; second admission, Sep- 
tember 11, 1906. 



Married : has had three children ; no miscar- 
riages ; menstrual historv was always regular ; 
had metapause at 45. 

Family history : Negative, except father died of 
Bright's disease. 

Past history : Had all diseases of childhood, but 
was always a strong child. 

Present history : Has not been well for three 
years, having suffered with a great deal of pain 
in the region of the bladder, and complains of 
dribbling of urine all the time ; has not much ap- 
petite : feels too weak to walk, and wants to stay in 
bed all the time. She also suffers at times with 
attacks of asthma. 

Arteries hard. Heart — a distinct mitral mur- 
mur is present, and can be heard very plainly. 

Lungs — on ausculation feeble visicular mur- 
murs, associated with wheezing sonorous rales. 

Percussion — hyporesonance over both lungs. 

Urine — albumin marked ; spg. low ; no sugar. 

Micropical — great abundance of pus cell; epi- 
thelium ; also hyline and granular casts. 

( )n the last admission to Bayview I made a 
careful examination, but could find no evidence 
of stone in the bladder, except pain and objective 
symptoms given above. 

1 ordered her irrigated, intending in the mean- 
while to watch developments. After a dav or two 
the nurse reported that she could not get the 
catheter into the urethra. I went down and tried 
it myself, and found the glass catheter struck 
something metallic and hard, which turned out to 
be a large stone situated in the lower part of the 
bladder, filling up the whole inclosure of the 
urethra. 

Owing to the age and extremelv bad physical 
condition of the patient. I hesitated operating, 
but, finding she could not void now without hav- 
ing the stone pushed back with a catheter to let 
the urine escape, and that this gave her much 
pain, I finally decided to operate, and after a lot 
of persuasion secured her consent to be operated 
upon. 

The operation was set for two days from this 
date, but in the meanwhile she was taken with a 
bad attack of asthma, which came near causing 
her death. 

However, this cleared up fairly well, and in a 
week I had her prepared for operation, having 
first previously ordered her to have plenty of 
water, a tonic T. I. D. and urotropin. grains 5, 
morning and evening. 



THE HOSPITAL BULLETIN 



i"5 



( >n September 28, 1906, at 10 A. M., she was 
brought in the operating-room prepared for op- 
eration. I desired to enter the bladder through 
the vagina, as I had to be quick and could give 
but very little ether, owing to the bad physical 
condition. 

I washed the vagina out well, and, having an 
assistant hold the vagina open with retractors, 
I passed a grooved steel male catheter through 
the urethra, the blade going downward. Using 
the catheter as a guide, I made a small incision 
about an inch below the urethra, cutting through 
the mucous membrane of the vagina into the blad- 
der. I next passed a pair of bullet forceps in. 
grabbed the stone and removed it intact, as you 
see by the specimen. 

I then washed the bladder thoroughly with a 
hot boracic solution, and after getting out as much 
pus as possible, I closed the wound with three 
fine black silk sutures, rather close together. Then 
taking two small rubber catheters which had been 
previously tied together and boiled, I passed them 
down the urethra into the bladder. 

Patient was removed to bed. I attached one of 
the catheters just mentioned to an irrigating jar, 
letting a hot boracic solution pass into the blad- 
der through one catheter and out into a pail 
through the other. I kept this irrigation up about 
36 hours, then examined the wound, and found it 
almost healed. At the end of five days I took 
out the sutures, and the wound was about closed. 
I got the patient out of bed into an easy chair. 
She voided involuntarily for about a week, but 
at the end of this time she suffered no pain or in- 
convenience, and in two weeks the wound closed 
entirely, and she was able to retain and pass her 
urine at her will. Owing to her age and general 
debility, she could not get around very well, but 
when I left Bayview, 1 1 months after, she was in 
good shape as far as the bladder trouble was con- 
cerned. 

April 5, 1909. 



ACADEMIC DAY AT THE UNIVERSITY 
OF MARYLAND. 



The University of Maryland's academic day ex- 
ercises, commemorating the one hundred and 
twentieth anniversary of St. John's College, which 
was affiliated with the university two years ago, 
were held at Westminster Presbvterian Church, 



Favette and Greene streets, Thursday morning. 
November 1 1. 

A memorial address in honor of John Prestiss 
Poe, late secretary of the regents, dean of the 
faculty of law, and for 40 years a professor of law 
in the university, by Judge Henry D. Harlan, 
marked the exercises. The degree of doctor of 
laws was conferred upon State Comptroller 
Joshua \Y. Heriug and Dr. Charles Horace Mayo 
of Minnesota. 

At 10.30 o'clock the faculty and students of the 
university assembled and marched to the church. 
The line was formed of students from the depart- 
ment of arts and sciences of St. John's College, 
the departments of medicine and pharmacy, the 
chancellor, the provost and regents of the univer- 
sity, the faculties and adjutant faculties, orators 
and guests and the alumni. 

The exercises were opened with an invocation 
by Rev. Thomas Grier Koontz, pastor of the 
church. 

In the absence of the provost, Mr. Bernard 
Carter, the greeting was made by Judge Henry 
Stockbridge. He declared that the occasion was 
one which brought the several departments of the 
university into closer touch and served as a me- 
dium for the interchange of greetings between the 
university and other institutions of the country. 

"It enables the university," he said, "to express 
its good-will and aims to its students and their 
friends and all others interested in elevating the 
standard of professional and technical training." 

Announcements of chairs to be filled to take 
Mr. Poe's place were made by Judge Stockbridge. 
Judge Harlan was elected to succeed Mr. Poe as 
dean of the law department, and Mr. William L. 
Marbury of the class of 1882 to lecture on the 
subject of torts during the second half of the 
year. Judge James B. Gorter will become lec- 
turer on evidence, and Mr. Joseph C. France on 
pleading and practice. 

This distributes among three the courses pre- 
viously directed by Mr. Poe. In accepting the 
position as lecturer on pleading and practice, Mr. 
France retires as lecturer on elementary law and 
jurisprudence. No selection has yet been made 
to fill the vacancy. 

Messrs. Hobart Smock and B. Merrill Hopkin- 
son sang "Guide, O Thou Great Jehovah." The 
balance of the musical program was under the di- 
rection of Dr. Hopkinson. 



1 7 6 



THE HOSPITAL BULLETIN 



Judge Harlan eulogized Mr. Poe, saying, in 
part : 

"It has been deemed appropriate that this first 
meeting since the death of the late dean of the 
law school, when are assembled the faculties and 
the students, many alumni and friends of this 
university, should not pass without some account 
of the life and tribute to the memory of one 
whose work has been so conspicious ; whose claims 
to the love and honor of all connected with it are 
so strong, and whose presence is missed today. 

"The duty of paying this tribute has been in- 
trusted by the regents to me. I regret, however, 
that I am not better qualified to discharge it ac- 
cording to its deserts. In view, however, of the 
fact that for 30 or 40 years, through which his 
labors were extended, I have been a daily witness 
of their performance, and for more than 25 rears 
— no inconsiderable period — have served with 
him in the school of law, I recognize that the 
mandate of the regents is not whollv unjustified, 
and it will afford me at least the opportunity to 
express my gratitude to and my abiding respect 
and affection for one who was my legal preceptor, 
ami for all these years my warm and devoted 
friend." 

Judge Harlan gave a history of the Poe family, 
and told of Mr. Poe's career as one of the State's 
ablest and most learned lawyers. He also told 
of the great interest Mr. Poe had always taken 
in the work of the university and his impression 
on the young men with whom he came in contact. 
He concluded by relating the bravery of such a 
distinguished man, and said it only remained for 
him to read the minute adopted by the regents. 
It told of their personal sorrow and the loss felt 
by the university. 

The principal address of the day was made by 
Dr. Archibald L. Bouton, professor in the de- 
partment of English literature at the University 
of New York. He spoke on "Is Culture Worth 
While?" and said in part: 

"Every autumn many of the colleges of New 
England set apart a dav called Mountain Day, 
when the students lay aside their work and ramble 
over the neighboring mountains, to appreciate the 
glorious outlines of the October landscape and to 
imbibe something of the serenity and strength of 
the hills. Every October the university with 
which I am concerned, with a somewhat anal- 
ogous motive, sets apart a clay called Founders' 
Day, in which the thought of our students is di- 



rected backward over the lapse of more than 75 
years, to dwell upon the personality and ideals 
of those who established the university. 

"To us in like manner Founders' Day brings 
an opportunity to draw strength to ourselves from 
contemplating the foresight, the self-sacrifice, the 
high idealism of the men whose labors have made 
the university and our present opportunities pos- 
sible. 

"I do not know how long the Lmiversity of 
Maryland has observed the custom of Academic 
Day. I know that as a university you look back- 
ward to your founding for more than a century 
of usefulness. I know little of the special cus- 
toms and ceremonies which have been associated 
with Academic Day in the past. I cannot be far 
wrong in seeing in it something of the character 
of an intellectual Mountain Day, when we may 
look for a broader outlook and meditate on some 
of the special problems of university life." 

Professor Bouton told of the university life 
and the many advantages of the culture to be 
had there. He pointed out a number of reasons 
why students should make something of them- 
selves and why they should aspire to know as 
much as their professors. 

In conclusion, he said : 

"The hour of our responsibility has come. In 
my attempt to present the conceptions of a real 
culture, it seems to me that in them lie the broad 
fields of a new land of promise, toward which 
America is now ready to move and to which the 
eyes of her people are already lifted." 

PORTRAIT OF MR. TOE PRESENTED. 

A portrait of Mr. Poe by Dietrich was presented 
the university by the students of the department 
of law. The presentation speech was made by 
Charles O. Laney, a student. It was accepted by 
Judge Stockbridge, and will be hung in the uni- 
versity. 

After the presentation honorary degrees were 
conferred on Drs. Hering and Mayo. In bestow- 
ing the honors a short sketch of their lives was 
read by the provost. Afterwards the students 
gave class yells and called for speeches. At one 
time the applause lasted five minutes. 

After the exercises, which lasted nearly two 
hours, the faculty and guests had luncheon at 
( iermania Msennerchor Hall. The St. John's Col- 
lege cadets returned to Annapolis on special cars 
of the Washington, Baltimore and Annapolis 
Electric Railway. 



THE HOSPITAL BULLETIN 



W/ 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

EDITED BY 

A COMMITTEE OF THE HOSPITAL STAFF 



PUBLISHED BY THE 

HOSPITAL BULLETIN COMPANY 
University of Maryland 



Business Address, 
Editorial Address, 



. Baltimore, Md. 
University of Maryland 



Baltimore, Md., November 15, 1909 

FOUNDERS' DAY. 

The exercises of Founders' Day at the Univer- 
sity of Maryland, held on November nth, were 
of an imposing and impressive character. The 
faculties and students of all the departments as- 
sembled on the grounds of the University and 
marched in a body to old Westminster Church, 
S. E. corner Fayette and Greene streets, where 
the exercises were held. 

In the absence of the Hon. Bernard Carter, 
provost, on account of sickness, Judge Henry 
Stockbridge officiated as provost, and conducted 
the services in a most happy and successful man- 
ner. 

The first address, delivered by Judge Plenry 
Harlan, was a memorial on the life and services 
of the late Hon. John P. Poe, for so many years 
Dean of the Law Department and Secretary of 
the Board of Regents. Judge Harlan paid a most 
beautiful and graceful tribute to Mr. Poe in an 
address marked for its scholarship and faithful 
presentation of the great services Mr. Poe had 
rendered the State and University of Maryland. 

The next address was delivered by Dr. A. L. 
Bouton of the University of New York on the 
subject, "Is Culture Worth While?" 

Dr. Bouton handled his subject in a most schol- 
arly and exhaustive manner, and succeeded in con- 
vincing the audience that culture is worth while. 

The honorary degree of LL.D. was next con- 
ferred by Judge Stockbridge on behalf of the 
Regents of the University of Maryland on the 
Hon. Joshua L. Hering of the class of 1855, now 
Comptroller of the State of Maryland and Presi- 
dent of the Board of Trustees of Western Mary- 



land College, and upon Dr. Charles H. Mayo of 
Rochester, Minn., the distinguished surgeon, who, 
on the 9th and 10th of November, had delivered 
lectures on the "Surgery of the Thyroid" before 
the students of the University and invited guests 
of the Faculty of Physics in Chemical Hall. 

The exercises were interspersed with vocal 
music under the direction of Dr. B. Merrill Hop- 
kinson, an alumnus of the University. It is es- 
timated that there were over 800 students of the 
various departments present, in addition to their 
friends and members of the different teaching 
bodies. 

This the second celebration of Founders' Day 
at the University of Maryland was a most success- 
ful occasion, and marks the permanent observance 
of this academic function in the future work of 
the University. 

In other words. Founders' Day has come to 
stay, and from year to year as time rolls on the 
exercises of this day may be regarded as mile- 
stones to mark the progress of the University in 
the great work she is destined to do in the world 
of education for the people of Maryland and for 
her growing student bodies filled with recruits 
from all parts of our land and foreign lands. 

This day, so auspiciously inaugurated last year, 
has done more to strengthen the bonds of union 
between the departments of the University and 
to build up a university life and spirit than all the 
agencies hitherto employed. Each year these 
bonds will strengthen, and at no far distant day 
the friends of the University will find an organi- 
zation and administration which will conduct the 
affairs of the University along broader and more 
progressive lines. As sure as the world runs 
its daily course, just so sure will these improve- 
ments and reforms come in the work of the old 
University. Her friends are growing, the public 
interest in her affairs is increasing and her present 
governing body is moving with caution, but with 
resolute purpose, in the right direction. Her con- 
tinued growth, usefulness and prosperity are as- 
sured. 



THE CARROLL FUND. 

Merit has her reward. The committee in charge 
of the Carroll Fund request no further contribu- 
tions be made, as sufficient money for the purpose 
in hand. Alumni of the University of Maryland 
should feel a pang of pride that the medical pro- 



THE HOSPITAL BULLETIN 



fession of the United States at large has adjudged 
the labors of a brother alumnus of so marked dis- 
tinction as to merit their contributions to help 
raise a mortgage on the home of his widow. The 
Journal of the American Medical Association edi- 
torially voices these sentiments on the completion 
of the fund: 

"It will gratify all to learn of the completion of 
the fund for a home for the wife of Major Carroll 
of yellow-fever fame. Major Ireland, of the medi- 
cal corps of the Army, who so kindly assumer 
charge of the receiving of remittances, announces 
that the contributions now in his hands are suffi- 
cient to pay off the entire indebtedness on the 
property and leave a small balance. Further con- 
tributions for this fund are, therefore, unnecessary. 
The committee is to be congratulated on the able 
and rapid manner in which it lias raised this 
amount, and the profession at large, and others, 
are to be thanked for the manner in which they 
generously and promptly responded to the appeal 
for contributions. The success of this undertak- 
ing is an evidence of the honor and esteem in which 
Dr. Carroll's memory is held for his self-sacrifice 
which led indirectly to his fatal affliction. In suf- 
fering himself to be bitten by yellow-fever mos- 
quitoes as one of the necessary steps in solving the 
problem of that disease, Dr. Carroll merely fol- 
lowed what seemed to him to be in the line of 
duty. But history inscribes his name among the 
heroes and martyrs, and enrolls among his debtors 
not only his profession and science, but also com- 
merce, his nation and the whole world." 



ABSTRACTS. 
Benigx Tumors of the Turbinated Bodies 
Clinically and PATHOLOGICALLY- 
CONSIDERED. 

According to Richard H. Johnston, class of 
1894, Journal of AM. A., July 24, 1909. Exclud- 
ing nasay polypi, benign tumors of the turbinated 
bodies are very rare. Less than twenty true papil- 
lomata of the nasal cavities have been recorded in 
rhinologic literature. In a special practice of 
eight years he has only seen clinically three benign 
tumors of the turbinated bodies, and has examined 
pathologically three other benign growths referred 
to him by other rhinologists. Of the six patients 
four were female and two males, their ages ranged 
from 1? to 60 years. In sum arizing he calls 
especial attention to the possibility of the trans- 
formation of benign into malignant growths. 



Mr. and Mrs. II. M. Turner, of Shepherdstown, 
West Virginia, have announced the engagement of 
their daughter, Miss Loraine Turner, to Doctor 
Nathaniel Burwell, class of 1907. Doctor Bur- 
well is a native of Clarke county, Virginia, and 
is a practicing physician of Shepherdstown. The 
wedding will take place in October. 

"The Recorder," the official organ of the "Su- 
preme Ruling of the Fraternal Mystic Circle," of 
August made the following eulogistic remarks 
about Doctor Arthur E. Ewens, class of 1904, 
of Atlantic City, New Jersey: 



THE LATE HON. JOHN P. POE'S CONNEC- 
TION WITH THE UNIVERSITV 
OF MARYLAND. 



Seldom in the life of a teacher, and especially in 
the case of a professional man in the pursuit of law 
or medicine, does it happen that a preceptor retains 
the same chair in an institution for a term ap- 
proaching twoscore years, but this honor belongs 
to Mr. Poe, who this fall began his fortieth year 
as professor of pleading and practice in the Mary- 
land University Law School. 

In October of 1870 Mr. Poe began his lectures 
on "Pleading and Practice," and in 1872 the addi- 
tional course of "The Law of Evidence" was 
added to his work in the law school. A third,sub- 
ject, "Legal Ethics," was assigned to him last year 
on account of the retirement of Prof. John J. Don- 
aldson from the chair of jurisprudence and ethics. 

In opening his course of lectures at the univer- 
sity several weeks ago Mr. Poe called attention to 
his long term of service and said : 

"Thirty-nine years is a long time, and in that 
span I have seen many students come and go. I 
also call to mind some of the most distinguished 
professors of this school, and some of the most 
conspicuous and eminent of our judges with 
whom I have been closely acquainted. I merely 
call this to your mind as an encouragement and 
inspiration to follow in the steps of your distin- 
guished alumni, and in the years to come to add 
fresh glory and renown upon your alma mater." 

"In the autumn of 1869 I was notified that the 
vacancies then existing in the board of regents of 
the School of Law of the LTiiversitv of Marvland 



THE HOSPITAL BULLETIN 



179 



had been filled by the election of Hon. George Wil- 
liam Drown (afterward Chief Judge Brown). 
Messrs. Bernard Carter. Henry Clay Dallam and 
myself. 

"We accepted the positions which we were then 
called to fill in the law department of the univer- 
sity. The exercises, which had been suspended 
for a number of years, were resumed. The de- 
partment was reorganized by the election of the 
late Judge John A. Inglis as the professor of law 
and as such a member of the board of regents, and 
the late Judge Robert X. Martin as a professor. 

"Lectures in the Law School were begun in 
February. 1870. and were regularly delivered to 
a very small class by Judges Inglis and Martin 
until the summer recess of that year. In the sum- 
mer of 1870 Judge Robert X. Martin died sud- 
denly, and the vacancy was filled by the election 
of Judge Alexander H. Handy, formerly Chief 
Justice of the Court of Errors and Appeals of 
Mississippi. 

"I was called to the chair of pleading and prac- 
tice in courts of law, and began my lectures in 
October, 1S70. My class during that university 
year numbered sometimes three and occasionally 
as many as seven. My lectures were all delivered 
at night. 

"In 1872 the additional subject, the 'Law of Evi- 
dence," was assigned to me. I have been continu- 
ally engaged in the work of instruction in this law 
school since 1870. 

"Prof. Samuel C. Chew of the faculty of physic 
and I are the only survivors of the board of 
regents at the time of ray election. 

"The late Severn Teackle Wallis was unani- 
mously elected in 1870 as provost of the university 
to take the place of Hon. John P. Kennedy, who 
had filled that office from 1850 until his death. Mr. 
Wallis held the office of provost until his death in 
April, 1894, and in June, 1894, Mr. Bernard Car- 
ter was elected provost, which office he still holds." 



ITEMS 

Dr. Ejnar Hansen, 41 E. 41st street, Xew York, 
writes to the Bulletin : 

"Inclosed a check for subscription. Could I 
from you get a iist of the physicians — graduates 
from our old school — now practicing in Xew York 
city? I should like to find them, and, if possible, 
start a little University of Maryland Society here 
in Xew York city. The Blt.letix is a welcome 



guest in my home every month, and I read it from 
beginning to end, trying in that way to keep in 
touch with the school hospital and old friends. 
Success to vou." 



Dr. Piatt W. Covington, class of iqo8, after one 
year of service as pathological to the Maryland 
Hospital for the Insane has returned to his home 
in Rockingham, X. C, for private practice. 



Dr. Summerfield B. Bond, chief medical exam- 
iner of the Baltimore &• < )hio Railroad, attended 
a joint meeting of the chief examiners of a num- 
ber of the more important railroads of the United 
States. The meeting was for the purpose of the 
interchange of experience and in a general way 
to promote the work of the medical and surgical 
corps under their direction. The meeting was 
held in the B. & ( >. Building', Baltimore. 



The senior class of the Medical Department of 
the University of Maryland has elected the fol- 
lowing officers for the ensuing year: President, 
Frank P. Fiery, Maryland; Yice- President, R. R. 
Diller, Maryland; Secretary, C. X. Devilbiss, 
Maryland: Treasurer, E. H. Kloman, Virginia; 
Historian, A. L. Little, Xorth Carolina ; Sergeant- 
at-Arms. M. S. Hanna, Egypt : Class Artist, G. 
S. Condit, West Virginia. Executive Committee, 
M. < 1. Hoffman, West Virginia 1 chairman ) ; W. 
A. ( Iracie, Maryland ; M. E. P.. Owens, South 
Carolina; J. E. Talbott, Maryland; J. II. Yon 
Dreele, Maryland; J. E. O'Neill, Maryland: T. 
Brooks, Cuba. 



The annual reception to the old and new stu- 
dents by the Young Men's Christian Association 
of the University of Maryland was given Mon- 
day evening, October 11, 1900, at 8 o'clock, in the 
association room, Davidge Hall. Dr. S. C. Chew 
and Judge Henry D. Harlan delivered addresses, 
and a pleasant musical program was rendered. 
Refreshments were served after the exercises. 



Doctors 

J. Wm. Funk. 
F. Caruthers, 
Wm. S. Smith. 
1 Carry Gross, 
A. D. McConachie, 
A. T. Chambers 
are visiting surgeons to Franklin Square Hospital. 



i So 



THE HOSPITAL BULLETIN 



Drs. C. Urban Smith and Win. II. Pearce are Dr. and Mrs. Cary B. Gamble, Jr., of 26 VV. 

visiting physicians to the Franklin Square Hospi- Biddle street, have returned from North Hatley, 

Canada, where they spent the summer. 



tal. 



Dr. T. J. O'Donnell is chief of clinic to the pro- 
fessor of operative surgery, Franklin Square 
Hospital. 



Dr. and Mrs. William Hewson Baltzell of Wel- 
lesley, Mass., are stoping at the Belvedere, having 
come to Baltimore for the wedding of Miss Agnes 
L. Selden. 



Dr. John S. Fulton has returned to Baltimore 
after spending the latter part of the summer in 
Europe. 



Dr. Thomas C. Worthington has returned from 
abroad, where he spent his summer vacation. 



Dr. J. N. Reik has returned home from Europe, 
where he attended the International Medical Con- 
gress at Budapest. 



Dr. Frank Martin is home after a delightful 
summer spent on the Continent. 



Dr. Ridgely B. Warfield summered in Europe. 



Dr. B. Bernard Browne, professor of gyne- 
cology in the Woman's Medical College, Balti- 
more, has resigned. 



Dr. J. Howard lglehart has been reappointed 
a medical inspector for the public schools of Balti- 
more. 



The junior class of the University of Maryland 
Medical Department has elected for the ensuing 
year the following officers: President, Willis 
Lynn, New York ; Vice-President, William L. 
Byerly, Maryland; Secretary, B. S. Boyer, Mary- 
land ; Treasurer, Louis H. Douglas, Maryland ; 
Historian, Henry D. Causey, Delaware ; Sergeant- 
at-Arms, Kenneth B. Jones, Maryland. 



Dr. and Mrs. J. Whitridge Williams have re- 
turned from an extended stay abroad, which they 
spent most of the time in 1 leidelburg, German}-. 
They have reopened their residence, 1128 Cathed- 
ral street, for the winter. 



Dr. William Dodd Scott, Jr., class of 1904, of 
Baltimore, has been confined to the University 
Hospital for the past month with typhoid fever. 
We are glad to report that he is canvalescing and 
well on the way to recovery. When he gets out 
he expects to return to his former home in Fred- 
ericksburg, Ya., where he will spend some time 
recuperating. 



At the section on Neurology and Psychiatry of 
the Baltimore City Medical Society, Friday, Oc- 
tober 15, 1909, papers were read by Dr. \V. F. 
Schwartz on "Psychasthenia," and Drs. I. S. 
Spear and R. P. Bay on "Astereognosis, with Re- 
port of Cases." 



Dr. Caleb Noble Athey, class of 1894, and Mrs. 
Athey, have returned from their honeymoon, 
which they spent in Europe. Mrs. Athey, nee 
Miss Helen Skipwith Wilmer, is a graduate of 
the Johns Hopkins Flospital Training School for 
Nurses. She met Dr. Athey while engaged in 
social service work. 



At the regular meeting of the University of 
Maryland Medical Association, held in the 
amphitheatre of the University Hospital Tuesday, 
< Ictober 19, 1909, at 8.30 P. M., the program was 
as follows : 

Peritonitis, Etiology — F. P. Fiery, class of 
1910. 

Symptoms and Diagnosis — Dr. Messick. 

Treatment — Dr. Shipley. 

This society was created especially for the pur- 
pose of bringing the faculty and student body 
closer together, both socially and instructively. 
At last we seem to have hit the keynote of success 
by obtaining the interest and co-operation of the 
students by appointing a member from the senior 
class to present a paper to the body. The selec- 
tion of the subject for discussion is left to a com- 
mittee of students, who, with the president of the 
society, arrange the program. 

These meetings are always very instructive, and 
this especial one was extremely so. The symp- 
toms, etiology and treatment of peritonitis was 



THE HOSPITAL BULLETIN 



181 



thoroughly discussed. There was also an election 
of officers for the ensuing year, which resulted as 
follows: President, Dr. John T. O'Mara ; Vice- 
President, Dr. C. W. McElfresh ; Secretary, Dr. 
Salvatore Demarco. 



Dr. Nathaniel R. Keirle, class of 1858, superin- 
tendent of the Pasteur Department of the Mercy 
Hospital, who celebrated his 76th birthday Sun- 
day, October 10, 1909, was given a banquet at 
the Maryland Club Monday night, October n, 
in recognition of his distinguished service to 
science in combating the ravages of rabies. The 
gathering included leaders in the medical pro- 
fession. 

All of Dr. Keirle's writings on rabies had been 
collected by his associates and friends in an at- 
tractive volume under the title "Studies in 
Rabies." The introduction was written by Dr. 
William H. Welch, the noted pathologist and 
scientist, while Dr. Harry Eriedenwald contributed 
a sketch of Dr. Keirle's life. 

Dr. Friedenwald presented the book to Dr. 
Keirle, and copies were later distributed to all the 
guests. Copies will be sent to medical libraries 
in this and foreign countries. 

In presenting the book Dr. Friedenwald said : 
"We have published this collection of your 
writings on rabies both for their intrinsic worth 
and as a mark of esteem and admiration of a large 
number of your friends and collegiates, who are 
present at this dinner given in your honor. 

"Your work as a teacher, the scientific stamp 
of your studies and publications, but most of all 
your painstaking and successful labors in the 
preventive treatment of rabies, have merited the 
highest approbation. Your care and accuracy, 
your untiring persistence and your unwillingness 
to accept conclusions until thoroughly proved 
have characterized you as a true scholar and an 
example of devotion to science. 

"You have not been spared disappointment, and 
you have suffered the greatest of sorrows, but you 
have borne them with heroic fortitude. Your 
friends have shared them with you, as th^y like- 
wise take pleasure in your labors and succecs. For 
them all we express the wish for your continued 
health, vigor and strength steadfastly to pursue 
vour beneficent work. 



"In presenting you with your writings in this 
volume we feel that in honoring you we are sin >\v- 
ing honor to a true physician, a real scholar, a 
rare, cultured and noble man." 

Others who spoke were Judge James P. C7orter, 
Dr. William H. Welch, Dr. William S. Thayer, 
Dr. A. C. Harrison, Dr. G. Milton Linthicum, Dr. 
John D. Blake, Dr. W. R. Stokes. 



Dr. and Mrs. Eugene F. Raphel are visiting in 
the West. On their return they will stop off at 
Buffalo, Niagara Falls and New York, and will 
spend a week with Mrs. Raphel's parents, Mr. 
and Mrs. A. V. Cherbonnier, 2230 N. Calvert 
street, before returning to their home, Woodlawn, 
Wheeling, W. \'a. 



We are glad to announce to the many friends 
of Dr. John T. King, who was compelled to go 
to Atlantic City for his health, that he has re- 
turned greatlv improved, and is again about his 
professional services. 



Dr. Albert Chase Trull, class of 1909, is to be 
congratulated as the high man at the last exami- 
nation of the Maryland Board of Medical Ex- 
aminers. Dr. Trull made a total of more than 91 
per cent. It is such as he who shed credit upon 
the old University and encourage us in our work. 
We are not, as some say, retrograding, but are 
surely and steadily coming to the forefront, as 
witnessed by our men leading not only the Mary- 
land Board, but also the North Carolina ; namely, 
Doctor Branch Craige. 

We have our faults ; so have the others. One 
on the inside always hears more about his own 
ailment than he does about his next door neigh- 
bor's. Instead of proclaiming them to the world, 
try to correct the imperfections. The best way 
to do this is, in common vernacular, to loosen up. 
Money talks. With an endowment we can and 
will imitate and go one better some of the richer 
institutions which are always held up to us as 
living examples of progressiveness. Could they 
or would they do any better than us with our 
means? We do not hesitate to reply no. 



We are sorrv to announce that Miss Frances B. 
Daniel, a graduate of the Nurses' Training School 
of the University Flospital, class of 1901, has been 



1 82 



THE HOSPITAL BULLETIN 



compelled to go to Saranac to take treatment. We 
are informed that .Miss Daniel is in very 
health. 



poor 



Dr. Lawrence Kolb. Assistant Surgeon United 
States Public Health and Marine-Hospital Serv- 
ice, has been relieved from duty at P»altimore and 
directed to proceed to the Reedy Island Quaran- 
tine Station and report to the medical officer in 
command for duty and assignment to quarters. 



Prof, and Mrs. John C. Hemmeter were guests 
of Prof. Franz Pfaff of the Faculty of Medicine 
of Harvard University. Prof. Hemmeter repre- 
sented the University of Maryland at the cere- 
monies of inauguration of Dr. A. Lawrence 
Lowell as president of Harvard University. 



At a meeting of the class of 1812 of the Uni- 
versity of Maryland (medical), E. P. Kolb was 
elected president ; E. S. Johnson, secretary, and 
J. E. Hubbard, treasurer for the ensuing year. R. 
A'. Parlett was elected vice-president and W. T. 
Chipman sergeant-at-arms. 

After the meeting there was a discussion as to 
the discontinuance of hazing, and the freshmen 
were informed that if they obey the rules made 
by the sophomores no more hazing will take place. 

The question of hazing in our schools, medical, 
dental and pharmacal, has become a serious issue, 
and it behooves the authorities of our institution 
to put their foot down on the practice and stamp 
it out every time it raises its obnoxious head. The 
men who enter our professional schools are sup- 
posed to have attended college and there to have 
indulged in such barbarious practices. When they 
enter the medical school they are presumed to be 
men who are done with babyism and to be ready 
for work. The sophomore class should be al- 
lowed to impose no restrictions upon the freshmen 
of any sort, and the first vear men should be en- 
couraged in every way to infringe upon the so- 
called privileges of the upper class men. 



Dr. II. Y. Righton of Savannah, Ga., lias been 
visiting friends in Baltimore. 



Dr. and Mrs. David M. R. Culbreth have re- 
turned from Spring Lake, X. J., and a trip 
through New York State, and have opened their 
residence, 1307 N. Calvert street, for the winter. 



Dr. and Mrs. Summerfield P>. Bond and their 
daughter. Miss Lydia Bond, have returned from 
North Hatley, Canada, where they spent the sum- 
mer, and are at their home, 1023 Cathedral street. 



Dr. George M. Settle of 2435 Maryland avenue, 
a graduate of the University of Pennsylvania and 
an assistant in the Nervous Department of the 
University of Maryland, was operated on recently 
at the University Hospital and is making a favor- 
able recovery. 



Governor Crothers has appointed Dr. W. P. E. 
Wise, class of 1889, of Baltimore county, a mem- 
ber of the Board of Visitors of the Asylum and 
Training School for the Feeble-Minded, vice 
Thomas Hill, deceased. 



Dr. I.. M. Allen, Associate Professor of 
Obstetrics, read a paper on Caesarean section 
before the Section on Gynecology and Obstetrics. 



Dr. James A. Nydegger, surgeon. United 
States Public Health and Marine Hospital Serv- 
ice, granted one month's leave of absence from 
September 10, 1909. 



Dr. Alberto L. Bartlett, class of 1904, has been 
made local head of the National Sanitary Board, 
Placentas, Cuba. 



Dr. H. W. Wickes. passed assistant surgeon. 
United States Public Health and Marine Hospital 
Service, granted fifteen days' leave of absence 
from September 1, 1909. 



Dr. James W. Hart, first lieutenant, Medical 
Reserve Corps, has been relieved from additional 
duty at Fort Washington, Md., and duty at Fort 
Hunt. Ya.. and ordered to proceed to Cayay. 
Porto Rico, for duty. 



Dr. James S. Fox, first lieutenant, Medical 
Reserve Corps, ordered to Fort Andrews, Mass , 
for temporary duty, and on its completion to 
return to his proper station. 



Dr. Eugene F. Cordell, librarian of the medical 
department of the University of Maryland, in- 
forms us that there are upon the shelves more 
than five hundred copies of general literature. 



THE HOSPITAL BULLETIN 



183 



This fact is not generally known, either by the 
profession or the student body, therefore we take 
this method of bringing it to your attention, both 
with the idea that our alumni in disposing of 
books of this character will not forget us and 
that students may avail themselves of the collec- 
tion. Dr. Cordell's idea in founding this branch 
of the library is not merely the creation of a 
nucleus from which in days to come a large gen- 
eral library may grow. It is his idea that our 
university should have books upon general topics 
for the relaxation and edification of our students. 
The editors of The Bulletin agree with him and 
solicit through its columns works upon general 
literature. Donors may rest assured that any 
contributions will receive proper care and atten- 
tion, as their donations will be housed in Davidge 
Hall under the supervision of Dr. Cardell. The 
editors also take this opportunity to thank those 
who have in the past contributed so generously 
to our library, and whose contributions have aug- 
mented the collection so that there are now about 
10.000 volumes upon the shelves. 



DEATHS 

Dr. Hammond Hampton Garner, class of 1902, 
of Lake Toxaway, N. C, surgeon of the steamer 
Dextero, died in the City Hospital, Santos, Brazil, 
South America, in July, aged 31. 



Dr. Felix Jenkins, class of 1849, on e of the 
best-known physicians of Baltimore, died Satur- 
day, October 9, 1909, within two days of the 85th 
anniversary of his birth at the residence of his 
son-in-law, Thomas W. Offutt, at Towson, Md., 
death being due to the infirmities of age. 

Dr. Jenkins was born in Baltimore October II, 
1824, at what was then 10 South street. He was 
a son of the late Felix Jenkins, and was educated 
at Mount St. Mary's College. After taking the 
full course in medicine he engaged in practice in 
this city. For 50 years he enjoyed a lucrative 
practice, and attained a high position in profes- 
sional circles. He retired from active practice 
about six years ago, though still retaining his 
residence. 400 Cathedral street, where he had 
lived for 25 years. Two years ago he was injured 
by a fall in front of the Cathedral, since which he 
has been an invalid. The past few months he had 
been visiting his daughter, Mrs. Offutt, at her 
country home near Towson. His wife, who was 



Miss Nancy Jenkins Conewauga of Pennsylvania, 
died three years ago. He was a member of the 
Cathedral parish, and had been a trustee of the 
church for many years. He is survived by Dr. 
Felix Jenkins, Jr., class of 1887, Benjamin W. 
Jenkins of Wilkes-Barre, Mrs. Hughes and Mrs. 
Offutt. 

The funeral took place Saturday, October 12, 
at 10 o'clock A. M. from the Cathedral, where a 
solemn high mass was celebrated. Cardinal Gib- 
bons was in the sanctuary during the mass and 
pronounced the benediction. The mass was cele- 
brated by Reverend Louis O'Donovan, assisted 
by Reverend P. C. Gavan as deacon, and Reverend 
William A. Fletcher as subdeacon. The honorary 
pallbearers were Messrs. Michael Jenkins, E. 
Austin Jenkins, Robert H. Jenkins, James Hunter, 
Charles J. Bonaparte, Richard Cromwell, Charles 
B. Tiernan, Dr. Edward F. Milholland, Dr. Rob- 
ert Johnston and Dr. Charles O'Donovan. The 
active pallbearers were Messrs. Josias Jenkins, 
George Edward Jenkins Shriver, Alfred J. Tor- 
mey. C. Hammond Cromwell, W. Kennedy Boone, 
J. Ramsay Barry and Alfred Jenkins Shriver. 



John Prentiss Poe, LL.D., Esq., Professor of 
Pleading, Practice, Evidence, Damages and the 
Law of Torts ; Dean of the Faculty of the School 
of Law ; Secretary of the Board of Regents, and 
member of the University Council for the School 
of Law, died at the home of his daughter, Mrs. 
Alfred Tyler, at Ruxton, Md., Thursday morn- 
ing, October 14, 1909, of paralysis, with which 
affection he had been stricken the previous Sun- 
day, aged 73. 

By the death of Mr. Poe the bar of Baltimore 
looses a most picturesque and noted figure ; the 
State of Maryland one of its most distinguished 
authors, and the University of Maryland a most 
valued counselor. The activities of Mr. Poe were 
manifold, lecturer, author of legal books and po- 
litical platforms, politician, after-dinner speaker, 
teacher, member of public-service boards, lawyer 
and indefatigable worker, and, above all, a public- 
spirited citizen. 

Mr. Poe was born in Baltimore on August 22, 
1836. He was 73 years old. His father was the 
late Neilson Poe, who was also a distinguished 
lawyer and author. His mother was Mrs. Jose- 
phine Emily Poe. Two of his brothers are still 
living — Neilson and Charles Poe. He was a 
second cousin by blood relation and a nephew by 



1 84 



THE HOSPITAL BULLET I > 



marriage of Edgar Allan Poe, the author and 
poet. Mr. Poe was educated at Professor Bous- 
sard's English and French School in Baltimore. 
and at Princeton, graduating from the last-named 
institution in 1854. at the age of 17 years. He 
entered Princeton in 1852 as a junior. Upon his 
return to Baltimore he secured a position as a 
bank clerk, devoting his spare time to the study 
of law under his father. He was admitted to the 
bar in 1857. Shortly after his admission to the 
bar he was appointed law librarian. After the 
war between the States he was associated with 
the late Gen. Bradley T. Johnson in the practice 
of law, the style of the firm being Johnson & Poe. 

In 1871 Mr. Poe was appointed a member of 
the City School Board, and served in that capacity 
for 17 years. He took a deep interest in the pub- 
lic schools and was instrumental in producing 
many reforms. During the administration of 
Mayor Wh'yte, 1882-84, Mr. Poe was City Coun- 
sellor. In 1885 he was appointed president of 
the City Tax Commission. 

In i88<) Mr. Poe was elected as a Democrat in 
the Second District to the State Senate to fill the 
unexpired term of Senator C. Ridgely Goodwin. 

In 1891 Mr. Poe was nominated by the Demo- 
cratic State Convention for Attorney-General, and 
was elected. 

In 1857 he received the degree of At. A. from 
Princeton, and in i<)04 was honored by his alma 
mater with the degree of LL.D. 

In 1863 he married Miss Alice J. Hough. Be- 
sides his widow, he leaves nine children — Messrs. 
S. Johnson Poe. who was associated with his 
father: Edgar A. Poe. City Solicitor: John P. 
Poe, Jr.: Arthur Poe of Cedar Rapids, Iowa: 
Wilson Poe. and Gresham Poe. and Mrs. Alfred 
Tvler, Mrs. S. N. Duer and Miss Margaret Poe. 



MARRIAGES 



Dr. Frank Owington Rogers, class of 1001. 
physician and surgeon ; secretary and treasurer of 
Cabarrus Count}- Medical Society, and Health 
Officer of Concord. N. C. one of the most popular 
members of his class and an athlete of note, was 
married Tuesday, October 26, 1909, at Galveston, 
Texas, to Miss Emma Antoinette Tillar. daughter 
of Mr. and Mrs. Frank Tillar of that city. 

Dr. Rogers is a native. of North Carolina, and 
was born < (ctober 21. 1876. He is a son of the 
late B. F. Rogers and Mrs. Mattie Ilarkey Rogers. 



I )r. Xathanie Burwell, class of 1907, a prac- 
titioner of Slu lstown, W. Ya.. and Miss 
Loraine Turner, uaughter of Mr. and Mrs. II. 
M. Turner, were married October 7, 1909, at the 
home of the bride by Reverend C. H. Rockey of 
Waynesboro, Pa. The wedding was attended only 
by near relatives and a few intimate friends. The 
bride received many handsome gifts, including 
silver and furniture from Carter Hall. Ya.. the 
ancestral home of the ^room's great-grandmother. 



Dr. Cleland G. Moore, class of 1909, of North 
Bend. Xeb., was ma ied ( October 5, 1909, to Mis, 
Emma G. Lewis, d liter of Mr. and Mrs. F. I. 
Lewis of 141 3 Mo l Uoh street. Baltimore. Md. 
The ceremony was performed by Reverend Ed- 
ward L. Watson. Strawbridge Methodist Episco- 
pal Church. Park place and Wilson street. Im- 
mediately after the ceremony Dr. and Mrs. Moore 
left for North Bend, where they will reside. 

Mrs. Moore is the third of sisters to marry 
physicians, and. strange to relate, the other two 
picked University of Maryland men as their help- 
mates: namely. Mrs. Tilghman B. Marden. wife 
of the Professor of Bacteriologv in the Baltimore 
Medical College, and .Mrs. M. R. Bruin, whose 
husband is a well-known surgeon of Strasburg, 
Va. 



Dr. S. Luther Bare, class of 11105. °f West- 
minster, Md., was married September 22. [909, 
at (irace Lutheran Church. Westminster, by Rev- 
en. nd P. H. Miller, the pastor, to Miss Nellie Ruth 
Schaeffer. The bride is the daughter of Mr. and 
Mrs. George R. Schafffer, and the groom is a 
son of the late David B -e. Dr. Bare was a mem- 
ber of the class of 1905,. and took a great interest 
in class affairs. He was very popular during his 
school days and liked bj everyone. The Bulle- 
tin extends to Dr. Bare its well wishes. 



Dr. James Knox Ins'ev, class of 1908, was 
married Saturday, Sept 'ber 18. 1909, to Miss 
Helen Horn, daughter . 1 Dr. and Mrs. George 
L. Horn. 



Charles C. Harris. D.D.S. and M.D.. class of 
1883. a member of the dental prefession and son 
of Prof. James H. Harris of the Dental Faculty, 
was married to Miss Oletia Gordon, near Paris. 
July 5, 1009. 



THE HOSPITAL BULLETIN 

I 

Published Month 1 n the Interest of the Medical Department of the University of Maryland 
PRICK $1.00 l'KK YEAR 



Contributions invited from the Alumni of the University, 
Business Address, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. V 



1 BALTIMORE, MD., DECEMBER 15, 1909. 



No. 10 



PLACENTA PREVIA CENTRALIS IN THE 

PRIMIPARA, AND 'REPORT OF 

ONE CASE. 



By A. Aldridge M Fthews, M.D., 
Surgeon St. Luke's Hoj (al, Spokane, Wash. 

Placenta previa is a condition which has been 
known of for about the past 200 years. About 
that time Portal and a little later Schacher wrote 
and described the condition quite accurately, but 
from that time until the time of Barnes no advance 
was made. Since then the condition has been writ- 
ten upon very extensively, and within the past two 
years there have been quite a number of splendid 
articles on this subject published. 

In a typical case of normal pregnancy the situa- 
tion of the normal placenta should be in the upper 
part of the uterus, above the so-called equatorial 
zone, and just below the opening' of the fallopian 
tube. It may be attached even to the anterior or 
posterior walls or to the fundus, the former being 
the more common. We know, however, that in a 
certain number of these cases this specific attach- 
ment does not occur, the ovum being implanted in 
the lower uterine segment, where it becomes a dis- 
tinct anomaly and under th name of placenta pre- 
via offering one of the mo. r> serious complications 
both for mother and child with which the obstet- 
rical surgeon has to deal. 

The various divisions w'hich the obstetricians 
divide the placenta previa into are placenta cen- 
tralis, lateral or partial and marginal. I shall not 
take up a description of the : se divisions, but I wish 
to take up the subject of, lacenta previa in the 
primipara, this being a ran. .complication in preg- 
nancy. 

As to the etiology of placenta previa little is 
known, but we do know that it is from four to six 
times more common in the multipara than in 
the primipara. Clinical observers show that 
chronic inflammation or congestion predisposes to 
this condition. 



1 )r. Hirst, in quoting Hoffmeir and Kaltenbach, 
furnished the best explanation for the abnormal 
situation of the placenta. These observers have 
demonstrated by the examination' of young ova 
that the corion villi in the lower pole of the ovum 
may develop in an hypertrophied dicidua rerlexa, 
thus carrying the placenta down to and across the 
internal os. at first an adhesion between the dicidua 
vera and the rerlexa is prevented by catarrhal dis- 
charge, but as the ovum develops the reflexa ma\ 
adhere to the vera, thus fixing the placenta in its 
abnormal situation, permitting its continued 
growth and giving rise to an apparent hypertrophy 
nf the decidua serotina. 

1 think I am perfectly right in saying that all of 
the American authors are of the opinion that 
where there is a primipara with placenta previa 
centralis past the thirtieth week of gestation, with 
a rigid cervix, that the best and most conservative 
treatment is an abdominal Cesarean section, both 
<in account df the mother as well as the child. 

Quoting Dr. De Lee : "In 59 cases of placenta 
previa treated by us three women died. One died 
of sepsis; she had been tamponed by a midwife 
at intervals for six weeks. One died of rupture of 
the uterus, the rupture having been produced by 
strong traction on a colpeurynter, combined with 
powerful pains which the traction evoked. One 
died of hemorrhage from a uterine tear produced 
spontaneously. This last patient presented evi- 
dence of a hemophilic tendency, a large bloody in- 
filtration developing in the left labium and extend- 
ing up into the abdomen. We take issue with 
Zweifel on the question of abdominal Caesarean 
section in placenta previa. In the case of central 
previa, with a close os at or near term, we would, 
surely perform the abdominal delivery. Baxton 
Hick's version, with subsequent spontaneous de- 
livery, is the method of choice when the facilities 
are not at hand for laparotomy. We always have 
felt there is a field for Caesarean section in placenta 
previa, in spite of Zweifel, Bumm, Schavata, 
Ehrenfest, Holmes and others, but the selection of 



1 86 



THE HOSPITAL BULLETIN 



the cases will always be a personal one not guarded 
by general and accepted principles in treatment." 

There is still great diversity of opinion as to the 
treatment of placenta previa, and these conditions 
have to be governed by the surroundings in each 
case; for instance, the condition of the mother, the 
condition of the child, the surrounding conditions, 
and last, bnt not least, the ability of the physician 
in attendance. 

If the mother's condition is good, she has not 
lost much blood. The cervix soft, which is usually 
the case in placenta previa centralis, the dilation 
could be done by the rubber bag and the Baxton 
Hicks version done as early as the cervix will 
permit. 

The packing of the vagina is recommended by 
some, and kept packed firmly until the cervix has 
had a chance to dilate, and if necessary these pack- 
ings should be changed, although there is consid- 
erable danger of hemorrhage back of the packing ; 
therefore, these cases should be watched very care- 
fully . and, too, every antiseptic precaution possible 
should be taken where the tamponing method is 
used, for they are especially likely to be followed 
by infection if our technique is not good, and even 
sometimes after every precaution. These cases, 
on account of the great seriousness, should be 
always, when possible, attended at a hospital, 
where we have every convenience to meet the 
many emergencies which might and are likely to 
arise. After making the diagnosis we should de- 
termine the condition of the child, and if in good 
condition and close to term, every effort should be 
made to save both mother and child, but if both 
mother's and child's condition are serious, even- 
effort should be exerted toward the saving of the 
mother, even though in so doing we may sacrifice 
the child, for the chances are exceedingly small at 
the best for the child. So many of these cases are 
premature, and even if born alive often do not sur- 
vive, and, too, if there has been much hemorrhage 
the chances for the child living are very slight, and 
I think I am justified in saying that if the preg- 
nancy is not further along than the thirtieth week 
the child should be absolutely regarded as a sec- 
ondary consideration, and every effort be made to 
care for and save the mother. The surrounding 
conditions will govern very much the mode of 
treatment of these cases, such as conveniences, 
help, etc., and where such conditions are not good 
and the proper help cannot be had, it is far better 
to attempt delivery by the Braxton Hicks method 



rather than resorting to the abdominal method, for 
1 consider when not in especially well-trained 
hands this class of work would be safer for the 
mother to be delivered per vagina and hope that 
she will be one of the small percentages that will 
recover under such conditions. 

The physicians, of course, vary as to their abil- 
ity, as there are very few good operating obstetri- 
cians in the general profession, to which I myself 
do not lay any special claim, and in these cases if 
an expert can be had it is far better for both the 
mother and child, for the general man naturally 
would not come in contact with these cases very 
often, and surely not sufficiently often to make him 
very familiar with this class of work. If the case 
is close to term, and the conditions will warrant it, 
better results could be had by doing abdominal 
( iaesarean section by a man accustomed to doing 
general surgery, if an expert obstetrician cannot 
be had. 

Coming, now, to the relative frequency of the 
condition, different authors estimate it to occur- 
ring with rather wide limits. Thus Mueller, whose 
statistics are based on 876,432 labors, show pla- 
centa previa to have been present in the proportion 
of 1 to 1078, Lomer 1 to 733, Tarnier 1 to 207, 
Williams 1 to 1000. McPherson, in an article from 
the Lying In Hospital of New York, states that 
there were 250 cases of placenta previa in 5200 
births, which gives a ration 1 to 208. Those closely 
approximate the figures of Tarnier. Dr. McPher- 
son further reports that out of 250 cases of pla- 
centa previa which occurred in primipara with a 
ratio of 10.66 per cent., leaving a percentage of 
89.43 per cent, for the multipara ; of the multipara 
those twice pregnant were in the majority, and 
thereafter up to the sixth pregnancy the even num- 
ber showed a greater per cent, than did the odd, 
although it was on a decreasing scale. 

As to the treatment of placenta previa, when we 
think of the mortality it makes the physician who 
who is unfortunate enough to have these cases 
quake, for the prognosis is always serious. Dr. 
Hirst gives a mortality of 40 per cent, for the 
mother and over 50 per cent, for the child. Wil- 
liams in quoting Mueller gives the mortality from 
36 to 40 per cent, for the mother and 66 per cent. 
for the child. 

The foremost and most usual method of treat- 
ment by the men who have had the largest obstet- 
rical experience and who are unquestionably the 
best qualified to determine the best procedure in 



THE HOSPITAL BULLETIN 



187 



these cases, are as a whole opposed to abdominal 
Qesarean section for complete placenta previa ex- 
cept in carefully selected cases. Newell quotes 
Hirst that in the hands of the general practitioner 
a mortality of approximately 40 per cent, in com- 
plete placenta previa, but believes in the hands of 
experts the ordinary mortality should be reduced 
close to 1 per cent. The maternal mortality in 
abdominal Cesarean section has been variously 
given up to about 20 per cent. ; therefore, when not 
in the hands of an expert obstetrician and a good 
surgeon can be had, I should strongly favor ab- 
dominal Caesarean section, as the mortality is about 
1 rue-half as great as when treated in the hands of 
the general man. I am of the opinion that the 
time will come when the abdominal Caeesarean 
section will lie the operation of preference. I do 
not see why the mortality of abdominal Caesarean 
section should be so high. I was of the opinion 
that it was much lower. I have only been asso- 
ciated in two other cases for abdominal Caesarean 
section, both of which made uneventful recoveries 
for mother and child. It is very true that many of 
these cases are in the extremest before the surgeon 
or obstetrician sees them, usually suffering from 
acute anemia due to the loss of blood, and that per- 
haps accounts for the high mortalitv in these cases 
which I before alluded to. 

In quoting Dr. Charles Jewett he reports 2010 
cases of placenta previa from German, French and 
Italian literature in the last few years. The ma- 
ternal mortality under the obstetrician method of 
delivery of 221 cases was 10.9 per cent., the fetal 
mortality of 1 159 was 57.3 per cent. ; 726 of these 
cases reported by Feuth were collected from the 
practice of midwives and general practitioners ; 
many were subjected to prolonged tamponing 
and were exhausted by needless hemorrhage ; ex- 
clusive of Feuth's cases the maternal mortality 
was 6 per cent, plus, and the fetal 6R.8 per cent. 

Comparing these results with 95 abdominal 
Caesarean operations, collected from seven pub- 
lications, all but one of the last year, the writer 
finds in the latter a mortality of 1 1.5 per cent, for 
the mother and 34 per cent, for the child. The 
principal danger to be overcome by the abdominal 
Cesarean section method is hemorrhage, lacera- 
tion of the uterus, sepsis, and also reducing the 
fetal mortality. 

Another question can very readily be raised, and 
that is, Are we justified in sterilizing these women ? 
I emphatically would say no, although there are 



man}- men of the reverse opinion who say that 
when consent of the husband and mother can be 
had it is a perfectly justifiable procedure. Flofer- 
meyer, J. O. Polak, E. W. Cushion, H. D. Fry, 
Charles Jewett, M. L. Baldy, J. W. Bovee and 
others are of this opinion, while Chas. W. Greene 
of Boston claims that it is not ethical and is 
morally unjustifiable to sterilize a woman when 
performing abdominal Caesarean section, even if 
she and her husband request it, for she may have 
children again, and even born normally, and if 
not normally could be delivered just as success- 
fully by an abdominal Caesarean section the second 
time as the first, and if such a request is made and 
acceded to, not only is the operation morally 
wrong, but in the event of second marriage it may 
be bitterly regretted. 

Dr. W. E. Ford is of the opinion that steriliza- 
tion should not be done. 

Then the question arises as to the best treat- 
ment to be followed in later confinements after a 
Cesarean section has been done. I can see no 
reason why a woman should not deliver herself 
perfectly normally, although there is a possibility 
(if the uterus rupturing, but I think all women 
should be given a chance to deliver themselves, but 
should be watched very closely during labor, for 
there is danger of the old scar being torn through 
by the severe muscular contraction which takes 
place, and for that reason she should always be 
confined in a hospital, where, if such should hap- 
pen, immediate assistance could be given her. 

Dr. Garrety concludes from his analysis of the 
literature on this subject that the obstetrician 
should aim to perform the later Caesarean section 
as near to term as possible, and yet before com- 
mencement of labor; with the onset of labor there 
is danger of rupture of the old cicatrix. There are 
usually scar changes and adhesions requiring 
modification of the classic technique, but the litera- 
ture does not show that the prognosis has been 
aggravated by them. Four, and even five succes- 
sive Caesarean operations have been performed in 
a few cases. The question whether to remove or 
merely incise the uterus in a later pregnancy must 
be determined by the strength of the uterine wall. 
If it shows signs of weakness or cicatricial tissue 
requires resection, hysterectomy rather than 
Caesarean section may be advocated for fear of 
rupture in later pregnancy. Adhesions which it 
is impossible to separate is another argument in 
favor of rendering the woman sterile ; therefore, 



[88 



THE HOSPITAL BULLETIN 



preferably by resecting' and ligating the two tubes 
hysterectomy is not deemed advisable. I also wish 
here to submit several personal communications: 

Dr. J. C. Webster. Chicago, October 7, 190c): 

"I am gradually coming to believe that abdomi- 
nal Csesarean section ( if the patient be in the hands 
of an expert operator) will come to be regarded 
as the wisest procedure in placenta previa in a 
primipara near term. Non-dilatation of the cervix 
and lower uterine segment is a most important fac- 
tor in its procedure, more over the retraction and 
contraction of the uterus following removal of the 
ovum effectually checks bleeding. I have once 
performed vaginal Cesarean section for placenta 
previa, but shall not employ it again for this pur- 
pose. ( Jrdinarily. I have used the Braxton Hicks 
bipolar version to bring down a lower limb, which 
acts as a plug and a dilator to the cervix." 

Dr. Barton Cook Hirst, Philadelphia. October 
2. 1909: 

"If the woman is well developed, the cervix 
elastic and somewhat patulous, I prefer the induc- 
tion of labor by hydrostatic dilatation of the cer- 
vix, the performance of pedalic version and slow- 
extraction of the infant. If there is any compli- 
cating factor, however. Cesarean section will give 
the best result for both mother and child in the 
hands of a trained abdominal surgeon." 

Dr. J. VVhitridge Williams, Baltimore, October 
2, HJ09: 

"I have had comparatively little experience with 
placenta previa in primipara, and thus far have 
delivered all of them by natural passage. My 
views as to the treatment in this class of cases are 
as follows: The use of the rubber baloon in all 
cases in which the cervix is sufficiently softened 
and dilated to permit its introduction. The rare 
cases in which the cervix is hard and apparently 
undilatable would appear to offer a limited field 
for either vaginal or abdominal Cesarean section. 
As. however, the cervix is nearly always softened 
in case of placenta previa, such an indication can, 
I believe, arise but rarely, and therefore the em- 
ployment of Gesarean section will have a very re- 
stricted field." 

Dr. L. M. Allen, Baltimore, October 13, 1909: 

".My ideas concerning the treatment of placenta 
previa in the primipara is, as soon as a positive 
diagnosis is made, empty the uterus. Of course, 
the method to be used depends upon the conditions 
in the particular case. In the case of a primipara, 



cervix intact, complete placenta previa, I believe 
abdominal Cesarean section will give the best re- 
sults. If it is the lateral or marginal variety, 
hemorrhage slight, the induction of labor by the 
introduction of bougies and vaginal tampoon, or 
simply lay rupturing the membranes is probably 
better. In a multipara in whom the cervix is soft 
and dilatable, slight manual dilation, followed by 
rapid version and slow extraction, having thigh, 
etc., act as wedge. If the placenta is not obstruct- 
ing the entrance into the uterus, often rupture of 
membranes will remedy the whole thing." 

Also I received two other communications from 
Dr. De Lee of Chicago and Dr. McPherson of 
Xew York, both referring me to articles which 
they had previously written and to which I allude 
in my paper. 

I wish here to submit a case which I think will 
be of interest : 

Mrs. G., wdrite ; female: married; occupation, 
housewife ; age, 24 ; family and past history nega- 
tive. 

Since the beginning of her pregnancy she has 
had splendid health, not even being annoyed with 
the ordinary inconveniences of early pregnancv. 
She has led a very active outdoor life, walking long 
distances almost every day. At about the end of 
the thirty-fourth week of pregnancy, upon awak- 
ening she noticed a feeling of moisture, and upon 
examining herself found that she was in a pool of 
blood, the approximate loss being about four 
ounces. The bleeding continued for a short while 
after awakening. I was immediately summoned, 
and found that the bleeding had ceased. She had 
not suffered any shock from the hemorrhage, hav- 
ing been lying perfectly quiet since her awaken- 
ing. Upon examining her I found that the fetal 
heart sound was good and strong, and upon a 
vaginal examination found the cervix rigid and 
hard, dilated sufficiently to admit the tip of my 
index finger, through which I could feel a rough 
granular soft mass. Symmetrically around the cer- 
vix and the lower uterus I could feel a thick, 
dough)- feeling substance between the hand and 
presenting part. I had her immediately trans- 
ferred to St. Luke's Hospital, where I had a con- 
stant attending nurse watching for further hemor- 
rhage. She did not bleed again until the next 
morning, 24 hours later, and. then only a small 
quantity. I appreciate now that I should not have 
waited until the next day, but should have oper- 
ated the morning of the first hemorrhage, for we 



THE HOSPITAL BULLETIN 



189 



can never tell what the next will be, whether mild, 
severe, or even fatal. The only operation I consid- 
ered in this case was an abdominal Cesarean sec- 
tion, for the reason she was a primipara having" a 
firm rigid cervix, a small vagina and placenta 
centralis. I also deemed it a much safer procedure 
for the mother than if the Braxton Hicks method 
were used, and if I had used such method I feel 
certain that I would have lost the child. The 
vaginal Cesarean section I did not consider, as not 
being familiar with it except from reading and 
seeing considerable number of criticisms in regard 
to this operation, although it is highly recom- 
mended by many German writers. 

< >peration. — Patient's abdomen was thoroughly 
prepared, also genitalia, a 1-5000 bichloride douche 
being given, patient anesthetized and ether being 
used as the anesthesia. A long incision was made 
through the linea-alba, the belly wall being very 
thin, the uterus was delivered, gauze and sterile 
towels being packed around between the uterus 
and abdominal wall and a vertical incision made 
through the uterus down to the membrane, which 
were then broken, a leg seized and the child lifted 
out of the uterus, cord clamped and cut. The pla- 
centa was centrally located over the cervix, peeled 
off very readily and the uterus was sewed up with 
chromic catgut. The hemorrhage was very small, 
being very much less than is lost usually at normal 
labor. My assistant caught the uterus close down 
around the cervix and held it firmly enough to pre- 
vent bleeding until after the placenta was re- 
moved. This, I think, was unnecessary, for I do 
not think there would have been any excessive 
hemorrhage. The abdomen was rapidly closed, 
and before removing the patient from the oper- 
ating table I examined the cervix, found it dilated 
to about the size of a quarter of a dollar, and still 
very rigid and hard. The patient made an un- 
eventful recovery, leaving the hospital on the 
eighteenth day. The child weighed six and three- 
quarter pounds. Both have since done splendidly 
up to the present date. 



THE NEGLECT OF THERAPEUTICS. 



Dr. Gordon Wilson of the University of Mary- 
land delivered an interesting address at the recent 
meeting of the Baltimore County Medical Society 
on the treatment of pulmonary tuberculosis. 
Among those present who discussed the paper 
were Drs. Joseph Gichner, R. C. Massenburg, 
Josiah S. Brown and F. W. Janney. 



By C. W. Mitchell, M.D., 

Professor of Medicine and Diseases of Children, 

University of Maryland. 

The relative neglect of therapeutics is one of the 
reproaches of modern medicine. Compared with 
the advance in all other branches of medicine, 
therapeutic progress has, indeed, been slow. The 
master minds in medicine have been almost solely 
concerned with the science, and have cared little 
or nothing for the art of healing. The pride be- 
gotten of scientific attainment has, as it were, 
blinded the eye of the physician to the real purpose 
of his calling, and he becomes so wrapped up in 
the means as to lose sight of the end. This atti- 
tude on the part of the profession has naturally 
brought about changes in the relative positions 
occupied by the physician and layman. The field 
of therapeutics is the only common ground upon 
which both stand, and the further removed from 
that ground the profession becomes, the greater 
the gap separating it from the public at large. Dr. 
C. G. Kerley aptly says : 

"The time when a physician can make a diag- 
nosis and cease his interest in the treatment of a 
case has passed. The faith of humanity in cura- 
tive agents is remarkable, and when the desired 
end is not reached by the first physician, some 
other physician is called, and when he fails the 
next resort is usually the charlatan and the pro- 
prietary and patent medicines. The prosperity 
of the irregular schools of various cults and sci- 
ences supposedly healing in character, and the con- 
sumption by the people of millions of dollars' 
worth of useless proprietary and patent drugs are 
to be attributed in a large degree to an indifferent 
application of therapeutic measures on the part of 
otherwise well-qualified medical men. A few 
great teachers of medicine have done incalculable 
harm by precept and example in their attitude to- 
ward therapeutics." 

Then, too, many sociological tendencies of the 
day serve to loosen the strong tie existing between 
patient and physician. The growth of specialism 
and the corresponding passing of the old family 
doctor tend to lessen the loyalty of the layman to 
his physician, because of the lack of that individual 
interest and sympathy which every patient claims 
as his right. However he may be imbued with the 
spirit of the modern industrial epoch, however 



190 



THE HOSPITAL BULLETIN 



firm a believer in organization, however in his 
life's work he may belittle the individual and exalt 
the multitude, the sick man of today, as ever, re- 
mains intensely individualistic, and the weakened 
hold that the doctor has upon the sick man is 
largely due to the fact that the glamor of the bril- 
liant successes of surgery, preventive medicine and 
educational crusades has distorted the vision of 
the medical man and dulled his keen perception of 
responsibility toward the sick individual. But, 
you object, education of the people will solve this 
problem. Education can never blunt a man's per- 
ception of his own physical suffering. A man with 
toothache is never noted for his altruism. 

When a man becomes a patient theories disap- 
pear and conditions occupy the center of the stage. 
Popular education does not alter this fact, btif 
rather emphasizes it. It is under the very shadow 
of the oldest and greatest university of this coun- 
try, in the city of the highest average civic intelli- 
gence, where public and charity practice are most 
efficiently organized, that we behold today the 
most remarkable spread of cultism. Boston is the 
veritable home of Christian Science and the birth • 
place of the Emmanuel Movement. But, you say, 
these are mere fads of the hour, and will soon fade 
away. Properly interpreted, they are only expres- 
sions of the eternal struggle of humanity for respite 
from suffering, and the loudness of the present 
cry only emphasizes the failure of the medical pro- 
fession to adequately meet conditions as they exist 
today. It is plainly the duty of the profession not 
to deride these movements, or to belittle their sig- 
nificance, but to honestly call itself to account. It 
is our duty to examine the causes of the present 
discontent, to ask how far we are responsible for 
it and what we can do to relieve it. 

Partial answers to the above questions are to 
be found as follows : 

First. — Therapeutic indifference on the part of 
great leaders in medical progress. 

Second. — Careless, unsystematic and improperly 
individualized instruction to medical students. 
"Prescription writing is a lost art" is a most trite 
but very true remark. Students are not taught. 
Great mergers in the drug business, as in the world 
of high finance, have swallowed up the small 
competitor, and pills are not rolled out by hand, 
singly, but turned out by the million from the ma- 
chine. The doctor has lost touch with the very 
tools of his trade, and therefore cannot be expected 
to construct their finished product. The manu- 



facturing chemist comes along to conjole the prac- 
titioner into the belief that his particular prepara- 
tion has some peculiar properties which could not 
possibly be reproduced by any combination the 
doctor himself might make. The groping after 
the mysterious in medicine is not limited to the 
laity, and after a while the doctor finally surren- 
ders and always orders C. & N.'s anti-opsonic 
blood builder because it gives results not achieved 
by the preparations of any other house. Thus is 
medicine practiced, and the doctor merges the in- 
dividuality of the patient, his lessons and symp- 
toms into those of the countless thousands for 
whom the preparation is made, his grip upon his 
patient gradually relaxes, until the despairing vic- 
tim of disease, finally escaping, seeks and often 
finds relief in the protecting arms of a cult which 
has its foundation upon the individuality of the 
patient. 

PLAN FOR INSTRUCTION IN THERAPEUTICS. 

Instruction should be obligatory upon all stu- 
dents of the third and fourth years. 

Pharmacological work not adapted to most stu- 
dents, because apt to be misleading. 

The experiments ordinarily performed in the 
physiological laboratory are sufficient for many of 
the most important drugs. 

During the third year didactic lectures by a 
clinician should be delivered upon about 30 repre- 
sentative drugs, following a physiological classifi- 
cation. ('Pharmacopeia and Physician.) Great 
stress should be laid upon the physiological actions 
of the drugs upon man, because confusion is pro- 
duced by too frequent reference to effects upon 
animals. No drugs should be dismissed without 
full discussion of the minor and remote effects, as 
well as of the important and prompt ones. 

Following description in the physiological ac- 
tion and logically and directly deduced from such 
effects, the therapeutic applications should be 
taught. It is only in this way that a rational foun- 
dation for prescribing can be laid. 

At each lecture parallel columns should be writ- 
ten on the board indicating the actions and uses. 
and there should always be included the writing, 
of a prescription for some imaginary individual. 

During the fourth year all groups for ward and 
dispensary instruction should be taught practical, 
individualized therapeutics, and every clinical lec- 
ture or conference should embrace prescription 









THE HOSPITAL BULLETIN 



tql 



writing by The students, together with a general 
discussion of the treatment of the disease seen. 
Whenever possible the United States Formulary 
should be used. 

Third. — The presence among practitioners of 
thousands of poorly-educated, badly-equipped men 
posing as specialists has done much to lessen the 
respect for and confidence in the profession felt by 
the public at large. Men just out of college, with- 
out any good general training either in public or 
private practice, aspire to all the privileges and 
emoluments of specialists. Their demands upon 
the profession and the public are ofttimes unbear- 
able. They cry aloud for positions on the teach- 
ing staff of our schools and for fat fees from the 
public. Their rampant commercialism destroys 
the faith of the public in the entire medical pro- 
fession, and the narrowness of their medical hori- 
zon often renders their therapeutic efforts not only 
useless, but positively harmful to their unfortunate 
patients. 

This evil is a growing one, and the responsi- 
bility for correcting it rests upon all of us. I be- 
lieve it can be met by enlarging the powers of 
licensing boards. I am convinced that the time 
will come when special licenses must be obtained 
to practice specialties, licenses which shall only be 
granted to those who, after proper post-graduate 
instruction, shall be able to show by examination, 
written and practical, proficiency in the special 
work which they select to follow. It is unjust to 
demand of the public special remuneration unless 
special or truly expert service be rendered. 

Lastly, the complexity of modern social life, 
with the increasingly great prevalence of mental 
and nervous affections, makes it, in my opinion, 
necessary that all medical men should receive 
proper instruction in psychology. It is the woeful 
ignorance of the profession concerning this branch, 
that has given the greatest impetus to the growth 
of Christian Science and the Emmanuel Move- 
ment. I have no confidence in the neurologist or 
psychiatrist of today who is untrained in psy- 
chology, and I hope soon to see the time when 
courses in psychology will be obligatory upon all 
students of medical colleges. 

The patrons of Christian Science and the devo- 
tees of the Emmanuel Movement will return to 
the medical profession, where they belong, only 
when the profession has demonstrated its ability 
to properly care for them. 



HYGIENE OF INFANCY. 



By Nathan Winslow., M.D. 

After the umbilical cord has been tied the baby 
is handed to a nurse, who should not only wrap it 
in blankets, but also carry it into a warm room ; 
for immediately after delivery the child, especially 
if premature or delicate, lias great difficulty in 
maintaining its animal heat at the proper point. 
Quite a number of children develop, from a lack 
of observing these simple precautions, coryza. 
As soon as possible mop the mouth out with little 
pledgets of absorbent cotton, in order to get rid 
of the mucus, but be careful hot to destroy any 
of its epithelium. The child should now be thor- 
oughly greased or oiled, in order to facilitate the 
removal of the vernix caseosa. The little one's 
eyes, after having been cleansed with a soft cloth, 
are protected with absorbent cotton, in order to 
prevent any water from running into them whilst 
the rest of the face is being washed. Alter these 
preliminary procedures the infant is immersed in 
a bath of a temperature of ioo degrees, so as to 
remove the vernix. If the mother has any puru- 
lent vaginal discharge, it is well to employ Crede's 
prophylactic method of washing the conjunctival 
sacs out with a drop or two of a 2 per cent, solution 
of silver nitrate. After the tubbing the obstetri- 
cian should carefully inspect the babe to see if it 
is normal, or if it has received any injuries during 
labor. He should examine the shape of the head, 
the body, the anus, and note any abnormality of 
the genitalia, for a tight, adherent prepuce in the 
male is conducive to a great many of the nervous 
symptoms of early childhood. If all is well, the 
stump of the cord is dressed with sterile gauze and 
cotton, just as any other open wound is treated. 
Some, however, prefer to dust the remnant of the 
cord with 1 part of salicylic acid to 19 parts of 
starch, and then to cover it with absorbent cotton, 
but the former method is preferable. Now the 
child may be dressed, placed in its crib in a dark- 
ened room and covered with blankets. If there 
are any signs of imperfect circulation, the feet 
should be wrapped in flannel and hot-water bags 
[nit in the crib. After six hours the child is put to 
the breast, so as to develop the nipple and to en- 
courage proper nursing habits. 

After the initial bath the child should be washed 
daily, but should not be immersed in the tub until 
the stump of the cord has sloughed off and the 



I'U 



THE HOSPITAL BULLETIN" 



umbilicus has entirely healed. After this a bath 
should be given at least once daily throughout in- 
fancy. The temperature of the water should be 
about 98 degrees for the first few months. Not 
until the head has been wet should the child be 
immersed in the water, and then it should not be 
allowed to remain in the tub more than a minute 
and a half. During the first six months the tub- 
bing temperature should be gradually reduced to 
95 degrees. At one year the temperature may be 
lowered to 90 degrees. By the time the child is a 
year and a half old it should be able to stand a tem- 
perature of 85 degrees, and at the end of the sec- 
ond year the temperature of the water ought to be 
down to 80 degrees. During the third year it is 
well to accustom the child either to cold plunges 
or shower baths of 70 degrees, the immersion last- 
ing from 30 seconds to one minute. After taking 
out, rub the child with coarse towels. The carry- 
ing out of this plan will greatly diminish the sus- 
ceptibility of the child to taking cold, and will en- 
able it to better withstand the changes of tempera- 
ture. When a child fails to react, as manifested 
by its shivering and the cyanotic hue of its skin 
when taken out of the tub, do not persist, but 
raise the temperature of the water. For purposes 
of cleanliness the warm bath given at night is the 
best, but for purposes of gymnastics the cold given 
in the morning. You can combine the two by giv- 
ing the warm and topping off with the cold. The 
"bath is not only useful for purposes of cleanliness, 
hut it also has therapeutical value. Fevers can 
often be warded off by the graduated bath, in 
which case the baby is immersed at 90 degrees and 
the water gradually reduced to 75 degrees. Again. 
we find it a very efficacious agent in contagious 
fevers not only for its antipyretic effects, but also 
for its property of allaying delirium. Moreover, 
it not onlv tones up the circulatory system in cases 
of sluggishness or congestion of the pulmonary 
circulation occurring in such diseases as measles, 
varicella, etc., but it also acts as a respiratory stim- 
ulant, owing to its shock to the nervous system. 
Hot baths may be advantageously employed in 
convulsions due to rickets or chorea. 

Among the very poor the children are over- 
dressed. On the other hand, in order to make a 
grand display, among the very rich, underclad. It 
is essential to the welfare and the proper develop- 
ment of the child that his clothing should be not 
only loose, but also should exert no pressure upon 
any portion of the body. Bands should not be 



pinned so tightly about the trunk as to embarrass 
the movements either of the chest or abdomen. 
The baby's wardrobe should contain the following 
articles : Abdominal binders, undershirts, napkins, 
flannel petticoats and dresses. The belly-band 
serves the purpose of protecting the intestines and 
of acting as a support to the abdominal wall. If 
sufficient adipose tissue is present in the abdominal 
walls it may be discarded after the third or fourth 
month. The chest should be covered with a knitted 
woolen undershirt, high in the neck and with long 
sleeves. The napkins ought to be made of some 
soft, absorbable material. This article of dress 
should be changed as soon as soiled, else the skin 
of the child will become inflamed and excoriated. 
Under no circumstance except upon railroad jour- 
neys is it permissible to employ rubber napkins. 
Do not permit the petticoats to be supported by 
waistbands, but instruct the parents to have them 
suspended by straps from the shoulders. The 
dress, the last article needed to complete the trous- 
seau, and the petticoat should extend some dis- 
tance below the feet, in order to keep them warm. 
All articles of clothing should be buttoned on the 
hack. These are all the garments needed by the 
child when indoors, but when baby goes out it 
should be better protected. Shoes and stockings, 
as they are soiled so often, are not necessary in- 
doors until the child commences to walk, but 
should be added to his other clothing when he goes 
out for an airing. 

The night clothing of infants should be as loose 
as possible, and should be made of the lightest 
flannel. The common mistake is to overload 
babies with covering at night, which is the ex- 
planation of much of the restless sleep. In older 
children, where there is a tendency to expose the 
feet, the night clothes should consist of a union 
suit with waist and trousers with feet. 

During exercise the movements of the child 
should in no way be interfered with by its clothes. 
It obtains its exercise by crying, kicking and 
numerous other movements. If baby is allowed to 
lie immovable in its crib it gradually fails to in- 
crease in weight, then after a while there is a loss 
of weight, its cry becomes weak, anorexia follows, 
and after a while there is indigestion. In order to 
prevent this sad state of affairs, we should make it 
our duty to carefully instruct the nurse to fre- 
quently change the position of the infant. 

The very best evidence of what a child ought to 
do is what it does. It begins to hold its head up at 






THE HOSPITAL BULLETIN 



193 



the time that the muscles of the neck permit, and 
it makes no endeavor to stand until the muscles of 
the lower extremity are properly developed. An 
ordinary child will commence to crawl about the 
fourth month. 

A child left to itself will make no efforts to 
muscular exertion of which it is incapable, so when 
it shows a desire to crawl or walk let it alone, and 
it will get all the exercise it needs. Walking 
should be spontaneous, and the cause of genu 
valgum is rickets. Generally speaking, premature 
walking does not affect the legs. 

When the child becomes older see that it gets 
enough outdoor exercise. We should encourage 
it to play ball, to ride bicycles, to run, to swim, to 
row, to skate and to indulge in all manly sports. 
The two sexes at this period should associate with 
each other as much as possible. 

In warm weather any healthy baby one week 
old, if its face and eyes are properly protected from 
the sun and wind, can be safely taken outdoors. 
If born in winter, postpone this event, but a hearty 
youngster after one month of age, weather per- 
mitting, if properly dressed, can be taken in the 
open air. Even 20 degrees F. in clear weather 
is no contraindication to this procedure. As a rule, 
every child should spend two or three hours on the 
street, and the only contraindications to this out- 
of-door airing are rain, high winds, damp weather 
and low temperature. In case of continued bad 
weather, or when the mother is afraid to allow her 
baby to go out because the mercury is below the 
freezing point, insist upon a constitutional airing. 
In this case it is well to remember that we can ob- 
tain some of the effects of an outing by taking the 
child, clad as if it were going out, from the nursery 
into another room. Then open all the windows 
and parade the child up and down. 

Sleep is one of the most vexatious questions with 
which we h? Tr e to deal in the management of in- 
fants, ye* there are some general rules which are 
laid down for our guidance. It is not wise to per- 
mit the new-born to sleep in the same bed with its 
mother. A child during the first month should be 
waked every two hours during the day and twice 
at night; during its second month of existence it 
should be aroused only once during the night, and 
after the fourth month it should not be disturbed 
between the hours of 10 P. M. and 6 A. M. It is 
bad policy to walk the baby to sleep or to give it 
sugar-tits, rubber pacifiers and the like to induce 
sleep, as it may form an unbreakable habit. So as 



soon as baby is through nursing put it in its crib; 
a warm bed, dry diapers, a dark, quiet room and 
its appetite fully satisfied are all the conditions that 
are necessary to cause the child to sleep. As a child 
grows older the sleeping hours gradually lessen, 
and a healthy child at 12 months of age should 
sleep about 15 hours out of 24 — 12 at night, 3 in 
the day divided into two equal parts. 

The skin of the infant is very delicate, and great 
care must be taken to keep it clean, but never use 
strong soaps for this purpose. When the napkins 
are wet they should be removed as soon as pos- 
sible, and all the folds of the skin should be kept 
dry by dusting them with talcum, stearate of zinc, 
etc. Sometimes plain water causes irritation ; then 
we resort to the salt or bran baths. 

Cleanse the eyes daily with boric-acid solution. 
It is better at first not to expose them to strong 
light. At night the child should sleep in a dark- 
ened room. 

Wash the mouth of the new-born daily for a few 
weeks. If there is any tendency to thrush, mop the 
mouth after each feeding with a 4 per cent, solu- 
tion of boric acid. When the child's teeth appear 
they should be kept clean, because they are liable 
to decay if neglected. 

The genital organs of the female need little at- 
tention. On the other hand, those of the male 
should be carefully watched. A long foreskin 
and a small preputial opening demand a circum- 
cision. 

After the child has nursed two or three times 
the physician should inquire of the nurse whether 
any meconium has been passed. The non-appear- 
ance of this substance indicates an atresia some- 
where in the digestive tract. Most frequently 
there is a membranous partition over the anus, 
which is very thin, and when opened corrects the 
malformation. On the other hand, if the obstruc- 
tion is higher up, an inguinal colostomy must be 
performed, else the child will soon perish. At 
three months of age a child ought to understand 
that it is to pass its feces while sitting on a chair 
made for that purpose. This alone is a great sav- 
ing to the mother, owing to the great amount of 
washing otherwise required. The child should be 
put in its chair as soon as it finishes nursing, and 
left there until its bowels have moved. Most chil- 
dren of nine or ten months of age can be taught a 
way to indicate a desire to defecate. 

It is much harder to teach the child about pass- 



194 



THE HOSPITAL BULLETIN 



ing its urine, but when it is one year old it should 
not wet its diaper during the night. 

In order to protect the brain, which grows more 
rapidly during the first two years than at any other 
period of life, from injury, insist upon freedom 
from all sounds, sights or stimulations, which call 
forth shrieks of laughter from the child ; for the 
healthy development of the cerebro-spinal matter 
demands rest, quiet, peaceful surroundings and 
absence of any unnecessary excitement. Owing 
to the numerous functional nervous disturbances 
in children, it is well for the attending physician 
to thoroughly instruct the parents in the proper 
hygiene of the nervous system, and to insist that 
the infant shall be kept quiet and not played with, 
especially at night, else harm will result to the child. 

The nursery should be a large, airy room, and 
situated on the second floor. It should be the best- 
ventilated room in the house, and should, if pos- 
sible, have a southern exposure, so as to insure 
adequate sunlight, which element is absolutely 
indispensable to the welfare and health of the 
child. The windows should be furnished with 
light, washable curtains. Free ventilation without 
draughts is an absolute necessity. This is best ac- 
complished by means of a ventilator made of an 
ell H iw of stovepipe and placed in the window. The 
nursery should be heated by an open fireplace. 
Wallpaper is an abomination, particularly that of 
today, which is of a very brilliant color, as it con- 
tains arsenic. As a consequence of this constituent 
quite a number of cases of chronic arsenic poison- 
ing have been reported. The walls should be 
painted and comparatively bare, and we should, 
dispense with all draperies that are not necessary, 
as the germs of the infectious diseases find a favor- 
able nidus in these articles. The furniture of the 
nursery should be as simple as possible. Pictures 
and moldings arc unnecessary, as they furnish a 
lurking place for pathogenic organisms. Floors 
covered with rugs or hard polished floors are more 
to be desired than those protected with carpet, as 
they can be more easily cleansed. The toys of the 
baby should be as far as possible indestructible, 
free from paint and adaptable to his growing mus- 
cular needs. If any light is needed at night, the 
ordinary wax candle is all that is necessary. The 
best form of heat is the open fireplace, and we 
should never permit steam heat or a gas stove to 
be used except for a few minutes in the morning 
during the bath. The temperature of the nursery 
during the day should not be over 68 or 70 de- 



grees 1 ; ., and we should always judge the tempera- 
ture by the thermometer, and not by our own 
sensations, or we will be apt to keep the room too 
hot, and an overheated room is frequently the 
cause of indigestion and loss of weight. At night 
during the early months the temperature of the 
bedroom should not be lower than 65 degrees, but 
after the first year it may be as low as 55 degrees. 
When the child is out of the room the windows 
should be thrown wide open and the room thor- 
1 Highly aired, and before the child is put to bed the 
nursery should be well aired. 

The advisability of sending the child to school 
is a very important as well as difficult question to 
decide. In the first place, a child should never be 
allowed to attend a school until the danger of that 
pupil spreading disease has been as far as possible 
removed : that is, a child should not be allowed to 
enroll as a pupil until vaccinated. Furthermore, a 
child who has been exposed to an infectious dis- 
ease should not be permitted to attend school until • 
the period of incubation of that malady is over. 

Again, you should not allow a child to go to 
school whose hygienic conditions you have not 
thoroughly investigated, as a very large number 
of the headaches of childhood is due to poor ven- 
tilation. It is evident that a child kept four or five 
hours in a badly-ventilated room, if exposed to 
damp or chilly yveather when school is let out, may 
contract a cold or pneumonia. 

I tefore enrolling a pupil his eyesight should be 
thoroughly examined, for a near-sighted child in 
a badly-lighted room or in a rear seat has con- 
stantly to squint at the figures on the blackboard, 
thus introducing one of the most powerful factors 
in the causation of the functional nervous dis- 
orders of childhood. It is a bad policy to force the 
child to continually use the right hand, as he is 
liable to become round-shouldered. In main of 
the large cities kindergartens have been intro- 
duced. Here the child is made to maintain the 
erect posture and the ventilation is good. They, 
however, have this disadvantage, the giving to the 
child the wrong idea of life, i. e., that life is only 
for pleasure. 



Dr. (.'harks Benson, son oi Dr. Benjamin R. 
Benson of Cockeysville, Md., has been appointed 
to the staff of Columbus Hospital, New York. Dr. 
Benson was until recently a member of the staff 
of Bayview Hospital. 



THE HOSPITAL BULLETIN 



195 



THE UTERINE CURETTE IS OFTEN A 

DANGEROUS AND HARMFUL 

INSTRUMENT. 



J. M. Hl-xdi.i:v, M.D., 

Clinical Prof essor Diseases of ]]'omcn. University 

of Maryland. 

This is an old subject. The dangers and acci- 
dents attending the use of the instrument have 
been written about over and over again. But if 
it is old and commonplace, and has been written 
about often, it is not as simple a procedure as it 
appears. I have seen two accidents that were 
most distressing, and many others not as serious, 
due to the faulty use of the instrument. 1 do not 
think a curettage tinder certain conditions a sim- 
ple operation at all. Xow, when the curette is 
possibly used oftener than any other gynecologic 
instrument, and used by every physician in active 
work, it becomes, by the very frequency of its 
use, a very dangerous and harmful instrument 
when used injudiciously. The operation of curet- 
tage is done for many varying symptoms and 
conditions. It is done for irregular, frequent and 
profuse uterine bleeding. When there is a sup- 
posed endometritis, curettage is also done, and is 
probably done oftener for this condition than any 
ether. The diagnosis of an endometritis is erro- 
neously based upon the fact of a leucorrheal dis- 
charge. It is the most frequent operation for the 
cure of painful menstruation. It is often done in 
a routine way, and without any positive indication 
whatever. 

Before doing a curettage for any condition, a 
history should lie gotten. To get a proper his- 
tory requires patience, tact and enthusiasm. It 
cannot be done in a half-hearted way. It is need- 
less to enlarge on the necessity of getting a thor- 
ough history. Without such a history there must 
lie frequent errors in diagnosis. For instance : 
Uterine hemorrhage may be due to an incomplete 
abortion or an ectopic pregnancy. It would be 
-noil judgment to do a curettage for hemorrhage 
due to an incomplete abortion, but it would be 
very bad judgment to do a curettage for hemor- 
rhage due to an ectopic pregnancy. 

After getting the history, the various organs 
of the body should be examined, ending with the 
pelvic organs. I remember many years ago hav- 
ing a patient with frequent and severe uterine 
hemorrhage. After using various drugs to con- 



trol the hemorrhage and failing, I did a curettage. 
It did no good. The woman had a scirrhosis of 
the liver, and her portal circulation was ob- 
structed. The hemorrhage continued unabated 
until her death, which occurred several months 
later. 1 have had two such cases. So it is neces- 
sary to make a general examination of the pa- 
tient. It is not right to confine our examination 
to the pelvic organs if we hope to do thorough 
work. Lastly, the pelvic organs should be ex- 
amined. One of the accidents alluded to in the 
first part of this paper occurred because the physi- 
cian assumed that the uterus was in its normal 
position of anteversion. and did not make a pelvic 
examination prior to operation. The woman had 
been bleeding for several weeks, and he attempted 
to do a curettage. The dilator was introduced 
into the uterus by directing its point upward, as 
is done when the uterus is in anteflexion or ante- 
version. The uterus was not in anteversion, but 
was retroverted and adherent. The inevitable re- 
'sult followed, the anterior uterine wall was pene- 
trated and torn and other damage was done, ne- 
c< ssitating a laparotomy. The currettage was in- 
troduced through the tear in the uterus and the 
curettage proceeded, when a loop of intestine was 
brought into view. That is a serious accident. 
In making the pelvic examination there are a 
number of other things to be borne in mind. The 
position of the uterus must be ascertained, and 
also its size, whether it i^ movable or adherent, 
whether it contains myomas, or if there is disease 
of the adnexa — such as inflammation or neo- 
plasms. I have now sufficiently emphasized the 
importance of getting a history, of making a gen- 
eral examination of the patient, and lastly of mak- 
ing tile pelvic examination before doing a curet- 
tage. 

Having done that, I shall now attempt to show- 
how the injudicious use of the curette can become 
dangerous and harmful when used : 

First — For Uterine Hemorrhage. — When the 
hemorrhage is due to an incomplete abortion the 
linger is the best curette. The curette is capable 
of great harm in this condition, especially if sepsis 
is present. The retained tissues can nearly al- 
ways be detached by the finger, and no harm is 
done to the uterine walls in using the finger. A 
curettage done with the finger is intelligently 
done, and there is no uncertainty as to whether 
the uterus is clean or not. Nothing is left behind 
when the finger is used. I have repeatedly re- 



io6 



THE HOSPITAL BULLETIN 



moved with the finger bits of placental tissue from 
uteri which had been previously curetted with the 
curette. No one can ever be certain that he has 
removed every particle of tissue from the uterus 
\\ hen the curette is used alone. I sometimes com- 
bine the two (the finger and the curette) in re- 
moving particles of tissue from the uterus. The 
specially adherent point is located with the finger, 
and then the curette is used. A number of years 
ago I had a very large curette made to be used in 
cases of incomplete abortion and after labor. In 
these cases, and especially if there is sepsis pres- 
ent, the uterine wall is very soft and friable and 
easily damaged, and often punctured by the or- 
dinary sized curette. I am satisfied the curette 
has been the means of doing much harm in this 
class of cases ; in fact, cases have terminated fa- 
tally from repeated curettages, when, if let alone, 
would have recovered. I have on three occasions 
punctured the uterine wall with a curette. For- 
tunately, no harm resulted, but it is not an agree- 
able experience. 

There are other sources of uterine hemorrhage 
than incomplete abortion. A myoma situated in 
the uterine wall is often the cause of persistent 
hemorrhage. The myoma may be very small and 
easily overlooked. A curettage to arrest hemor- 
rhage from this cause would do no good, and 
might do much harm. As I am not writing of 
uterine hemorrhage, but of the danger and harm- 
fulness in the use of the uterine curette, it is not 
necessary to go more fully into the cause of uter- 
ine hemorrhage. 

My second subject is Curettage for Endome- 
tritis. An acute endometritis should never be 
curetted. Cullen examined a number of uteri re- 
moved by supravaginal hysterectomy for pus 
tubes, and failed to find a chronic endrometritis 
in any one of the uteri. An acute endometritis 
seldom ends in a chronic endometritis, but in com- 
plete recovery. The leucorrheal discharge, which 
is so common in women, is oftener due to disease 
of the cervical mucosa than to the corporeal en- 
dometrium; therefore, a curettage seldom arrests 
this discharge. Amputation of the cervix is the 
proper procedure in certain cases in my judgment, 
and not a curettage. Many times this leucor- 
rheal discharge is kept up from inflammatory 
disease of the tubes and ovaries. Curettage for 
a gonorrheal endometritis seldom results in a cure. 
The so-called glandular or hypertrophic endome- 
tritis is benefited and cured by a curettage. 



Aly third subject is Curettage for Dysmenor- 
rhea. Curettage for dysmenorrhea seldom, if 
ever, results in a cure, but frequently in harm. 
Dysmenorrhea is rarely due to disease of the en- 
dometrium, but is oftener due to errors of de- 
velopment of the uterus, poor health and over- 
work. It is often associated with neurasthenia, 
and is rarely due to mechanical causes, such as 
anteflexion and retroflexion. Inflammatory dis- 
ease of the adnexa and myoma in the uterus are 
causes of dysmenorrhea. I believe the damage 
done to the uterine mucosa by the curette in these 
cases often does more harm than good, and is 
often the cause of scanty and painful menstrua- 
tion. If the curette is used at all in these cases, 
it should be used very gently. I have almost 
come to the point of discarding the curette in the 
treatment of dysmenorrhea altogether. The in- 
judicious use of the curette in this class of cases 
does not harm through injuryto the endometrium. 
It is conceivable when the operation is repeated 
several times (and that if often the case) and 
where considerable force is applied to the curette 
that great damage may and can be done to the 
musculature of the uterus, as well as to the en- 
dometrium. With this changed endometrium, 
scanty and painful menstruation is sure to occur. 
Curettage is frequently done in a routine way, 
and without any positive indication for the opera- 
tion whatever. This is reprehensible. From a 
large experience I believe a large percentage of 
all curettages are useless, and often harmful. 



REPORT OF THREE CASES OF PERFO- 
RATING ULCERS OF STOMACH, 
WITH TWO RECOVERIES 
AXD ONE DEATH. 



Reported by G. Hampton Richards, M.D. 
Assistant Resident Surgeon University Hospital. 

Perforating gastric ulcers with recover)- are 
rare. Gastric ulcer so diagnosed is rather com- 
mon, but, as has been reported in several articles 
of recent publication, it has been shown that many 
supposed gastric ulcers at operation prove to be 
gall-bladder conditions of various kinds. 

Case No. I, which is reported below, had been 
treated for indigestion for the last 18 month-. 
The man had never been given a test meal nor had 
the stomach contents ever been examined. This 



THE HOSPITAL BULLETIN 



197 



only proves the old story — someone failed to use 
all the means of diagnosis available for the proper 
differentiation of the case. 

There are two points which were found in these 
cases which are not mentioned in textbooks, as 
far as I remember. They are, first, the red blood 
which the patients speak of in the stool; second, 
the general contour of the abdomen — concave in 
the upper portion and convex in lower. 

Case I. — Operated upon by Dr. J. W. Holland, 
in the service of Prof. J. Holmes Smith. 

The patient was admitted to hospital about 12 
o'clock midnight, January 9, 1909, complaining of 
intense pain in his abdomen, which came on about 
one hour before admittance to the hospital. 

Name H. M. ; male; colored; age $% years; 
height 6 feet I inch; weight 151 pounds; occupa- 
tion, waiter; social condition, married; family his- 
tory, not important. 

Past history : The patient has had very little 
illness until about one year ago, which his present 
illness dates back to. He has been a waiter for 
the past eight years. His meal times have been 
very irregular, and he would often eat between 
meals ; very often he would taste soups and liquids 
of various kinds when they were hot. About one 
year ago he began to suffer with pain and full- 
ness about the stomach. He was treated some 
time for indigestion, but was not relieved. He has 
lost about 30 pounds in weight within the last six 
months. The pain was most severe about one 
hour after meals, and at times it would cause him 
to stop work and sit down. 

Present illness : About one hour previous to 
entrance he was sitting down to eat, when he was 
taken with a violent pain in the upper abdomen, 
just about the median line, one and a half inche > 
below the ensiform cartilage. He was brought 
to the hospital in an ambulance and placed in bed. 

An examination showed the following: Abdo- 
men very rigid ; so much so, one could not pal- 
pate deeply at all. The abdomen was concave 
from the ensiform cartilage to the umbilicus, and 
convex from this point to the pubes. Tender over 
the entire right side — more so over the gal! blad- 
der region. The patient complained of very se- 
vere pain, which was constant. Temperature 
97/45° by mouth, 90/5° by rectum; pulse 90: res- 
piration 24 per min. Patient's expression very 
anxious, and the tongue dry, but clean. When an 
operation was mentioned to the patient he ex- 



pressed himself as not caring what was done. -< < 
he was relieved. Pleart and lungs normal. Urine 
showed nothing of interest. An examination 
showed the rectum free of hemorrhoids and the 
mucous membrane normal. Nothing could be 
palpated in the pelvis by rectal examination. The 
patient's bowels had not moved for 24 hours. An 
ice bag was placed over the gall-bladder region, 
and one ounce of magnesium sulphate was ad- 
ministered ; also morphia, and the patient made 
ready for operation. Seven hours later his bowels 
did not move. No vomiting. An enema was 
given, which was not effectual. A second enema 
was given, with high enema tube inserted well up 
into the rectum by means of the finger, which was 
not effectual, and had to be siphoned off. The pa- 
tient was taken to the operating room, and an in- 
cision in the median line of the abdomen, extend- 
ing from about one inch below the ensiform carti- 
lage to the umbilicus, was made. As soon as the 
peritoneum was opened gastric contents were 
found free in the peritoneal cavity; this was 
sponged out and the stomach exposed. The gall- 
bladder was found to be adherent to the pyloric 
end of stomach. There were a great many ad- 
hesions about the gall-bladder. These adhesions 
were broken, and in doing so the gall-bladder was 
released from the pylorus. This exposed an ulcer 
about the size of a dime. The ulcer resembled a 
punched-out hole in the anterior wall of the py- 
lorus very much like a cautery burn. 

The ulcer was closed with fine silk sutures. V 
posterior gastrojejunostomy was performed by 
means of a Murphy button. The patient was 
drained by means of rubber tissue tucks, one be- 
ing placed in the lesser peritoneal cavity. The in- 
cision was closed up to the drainage tubes. The 
patient was placed back in bed, and nothing al- 
lowed by mouth for 48 hours, and he was given 
normal salt solution by the rectum during this 48 
hours. He was dressed daily, and the tucks were 
removed. Patient's temperature did not exceed 
100° any time during the illness. About 19 days 
after the operation he began to have pain in re- 
gion of stomach, and up to this time he had only 
been allowed soft diet. As gastric ulcer i; gener- 
ally found in the presence of hyperchlorhydria, 
and he was not getting sufficient proteids in his 
diet, he was allowed meats, and his pain disap- 
peared. 

He was discharged from hospital after gain- 
ing in weight and having no discomfort whatever. 



198 



THE HOSPITAL BULLETIN 



Case II. — Operated upon by Trot". Randolph 
Win slow. 

Patient entered hospital January 2, 190 1. com- 
plaining of intense pain in upper abdomen. 

Male: white; age about Oo years. 

Man could not -peak English, so his history 
was very deficient. 

Family and past history could not be gotten 
and, indeed, only very little could be gotten from 
patient to aid in diagnosing his case. 

An examination showed the following: Heart 
and lungs practically normal : abdomen concave 
in upper portion, convex in lower; very rigid and 
tender ; more tender over upper and right quad- 
rant. The mouth was dry and the tongue coated. 
No history of vomiting. The rectum was dis- 
tended, but nothing could be palpated. He was 
advised to be operated on, but refused until next 
morning. January 3, when he consented. By this 
time his condition was hopeless. He was pre- 
pared in usual aseptic manner. The peritoneal 
cavity was opened in median line, and found con- 
taining gastric contents. This was sponged out. 
and an ulcer was found situated at the pyloric 
end of stomach, on the anterior surface. The 
ulcer was closed, but his condition was such that 
nothing further could be done. The wound was 
drained and patient placed in bed. He died a 
few hours later. 

Case III. — Operated upon by Prof. Randolph 
Winslow. 

Patient entered hospital July 31. kioi, com- 
plaining of pain in the abdomen. 

Male; white: age 50 years; occupation, steve- 
dore : family history, nothing of importance. 

Past history : He has had some of the diseases 
of childhood, but does not know which. He had 
"malaria"' several years ago. He has been suffer- 
ing with pain in stomach for last two year-. 
This pain was more marked about one hour after 
meals. He was treated in Pittsburg for "gas- 
tritis" for sometime without relief. He later 
came to this city, and was examined by several 
physicians, and all pronounced him healthy, and 
advised him not to pay any attention to the pain 
in hi- abdomen. The pain did not cease, but con- 
tinued to grow worse until July 31, 1900, when 
he was brought to this hospital. 

Present illness: Patient gives following his- 
tory: Five hours previous to entrance he was 
taken with a severe pain in the abdomen, in the 
upper right quadrant and in the median line. 



This pain was of a very sharp lancinating nature. 
He had never experienced such attacks, nor had 
he ever been jaundice. Later the pain was gen- 
eral all over the abdomen. No history of vomit- 
ing. His mouth was dry and tongue coated. He 
had an expression of intense anxiety upon his 
face. An examination showed the following : 

Heart and lungs normal ; urine, dark amber 
color; reaction acid. Sp. Gr. 1032: sugar, nega- 
tive: albumen, positive, heavy rings: sediment, a 
few leucocytes and epithelial cells. Ten days 
later albumen in the urine could not be found. 

His abdomen was of same contour as above 
mentioned, convex in upper portion and concave 
in lower : very rigid and tender, more tender over 
the right hypochrondriac region ; rectum normal : 
leucocyte count 13.500; temperature 99 4 - : 
pulse 105: respiration 50. 

The patient was gotten ready for operation at 
once. An incision was made in the median line 
extending about two inches above and below the 
umbilicus and to the right of the same. The peri- 
toneal cavity was opened, and gastric contents 
were found. There was an ulcer found located 
on the anterior -urface of the pylorus. This was 
closed with silk, and a posterior gastroenteros- 
tomy was performed by means of clamps and 
.-ilk suture. The peritoneal cavity was well 
-ponged out and drainage placed in upper por- 
tion, as well as another opening made over the 
pubes, and a drainage tube placed in the pelvis. 

The patient was placed back in bed and kept in 
the Fowler position. He was not allowed any- 
thing by mouth for 48 hours, when he was then 
allowed ice and one ounce of water every two 
hours, which he retained. 

The next day he was allowed liquids, and two 
days later soft diet. He was dressed daily. 

For the first 24 hours drainage was profuse. 
After this there was very little. The tucks of 
upper abdomen were removed, and later the one 
from the pelvis. The wound healed very nicely. 
J J is temperature never exceeded 101 and pulse 
103. The respiration came down to normal soon 
after operation, and remained so. 

Patient was discharged from hospital 15 days 
from time of entrance cured. 



The resident physicians and clinical assistants 
of the University Hospital gave a ball to the nurses 
Monday. November 29, 1909, at Albaugh's 
Theater. 



THE HOSPITAL BULLETIN 



199 



THE PR( >FESSORS OF SURGERY IX THE 
UNIVERSITY OF MARYLAND. 



By Randolph Winslow, M.D., 
Professor of Surgery, University of Maryland. 



No. 4. — Nathan Ryno Smith, M.D., LL.D. 

Dr. Nathan Ryno Smith was the most distin- 
guished man who has ever occupied the surgical 
chair in the University of Maryland, with the ex- 
ception, possibly, of Dr. YY'm. Gibson, whose dis- 
tinction came chiefly after his removal to Philadel- 
phia, where he became professor of surgery in the 
University of Pennsylvania : but with Dr. Smith 
it was different, as he achieved his reputation here 
in Baltimore, whilst the incumbent of the chair of 
surgery in the University of Maryland, which 
position he occupied about 50 years. He was born 
in Cornish, N. H.. on the 21st of May, 1797. being 
the second son of an illustrious father. Dr. Nathan 
Smith, subsequently professor of medicine and 
surgery in the Medical School of Yale College. 
Dr. Nathan R. Smith received his classical educa- 
tion at Yale, where he graduated with the degree 
of A.B. in 1817. He also pursued his medical 
studies at Yale College, and received the degree 
of Doctor of Medicine there in 1823. He first 
practised at Burlington, Yt., and whilst there 
assisted in the organization of the medical depart- 
ment of the University of Vermont, at which he 
was the first professor of anatomy and surgery. 
He spent the winter of 1825-6 in Philadelphia 
pursuing studies at the University of Pennsyl- 
vania, and became associated with Dr. George 
McClellan and others in the establishment of Jef- 
ferson Medical College, where for two sessions he 
held the chair of anatomy. Amongst his pupils at 
Jefferson Medical College were Samuel D. Gross, 
subsequently the Nestor of the American medical 
profession, and Washington L. Atlee, who became 
a renowned surgeon. Upon the resignation of 
Professor Pattison. Dr. Smith was elected to the 
chair of surgery in the University of Maryland, a 
position which, as has been stated, he held for 
nearly 50 years. He found Baltimore a ripe field 
for surgical practice, and so thoroughly did he 
dominate surgical thought and work in this city 
and State that he became known widely as the 
Emperor, and to this day those of his pupils who 
are living still cling to this term. At the time of 
his removal to Baltimore he was about 30 years of 



age, and he continued to live here until his death 
in 1877. During the time of the troubles between 
the trustees and the faculty of the Medical School 
he accepted the chair of practice of medicine in 
Transylvania University at Lexington, Ky., and 
for three sessions traveled backward and forward 
to fulfill the duties of his position. Pie delivered 
some lectures during this time, however, also at 
the University of Maryland, and upon the read- 
justment of the affairs of the University of Mary- 
land he resumed his professorship of surgery, in 
1840. In 1867 he visited Europe and became per- 
sonally acquainted with the most distinguished 
surgeons of Great Britain and the Continent, by 
whom he was treated with great respect and at- 
tentii m. " ! Yofessor Smith was a manof command- 
ing presence, fully six feet in height, with clean- 
shaven face, a well-shaped Grecian nose, long, 
thin, compressed lips, piercing eyes surrounded by 
shaggy eyebrows, a well-poised head and a long 
neck concealed by an old-fashioned black stock 
and standing collar. He was near-sighted, and 
wore glasses." He lectured without notes, and in 
slow, deliberate fashion, in a voice of medium 
pitch, distinct, though not strong. He was an in- 
defatigable worker, and was accustomed to make 
his rounds at the Baltimore Infirmary, now the 
University 1 lospital, about 6.30 o'clock in the 
morning. Whilst his surgical work was very 
varied and extensive, his reputation rests chiefly 
upon his lithotome, an instrument for the perform- 
ance of lithotomy, and the anterior splint. It is 
said that he operated for stone in the bladder about 
350 times, with a very low mortality, a large por- 
tion of his success, as well as that of his son, Dr. 
Man P. Smith, in these operations being due to 
their use of this lithotome. The anterior splint, 
for the treatment of fractures of the lower extremi- 
ties, was a great improvement on the methods in 
vogue at that time, and was considered by Pro- 
Eessi 'i" Smith to have been his chief contribution to 
surgery. This splint has now fallen into unde- 
served disuse, and is as capable now of rendering 
good service as it was when perfected by him in 
i860. The Hodgen splint, which is being used 
satisfactorily in some parts of this country, is 
merely a modification of the anterior splint of Dr. 
Smith, and the usefulness of both of these instru- 
ments is due to the fact that the limb can be swung 
and a certain amount of motion permitted without 
interfering with the healing process. The prin- 
ciple upon which this was based was that of the 



200 



THE HOSPITAL BULLETIN 



double inclined plane, with suspension. During 
the Civil War the anterior splint was used with 
the greatest benefit and comfort in the treatment 
of soldiers suffering from compound gunshot frac- 
tures of the lower extremities. He resigned his 
chair in the University in 1870, but until his death 
continued a nominal connection with the school 
as president of the faculty and emeritus professor 
of surgery. As has been said by Professor Chew 
in an address commemorative of Dr. Smith, "he 
has left behind him the record of a great surgeon, 
a brave and true citizen, a magnanimous gentle- 
man. Full of years and honors, he rests from a 
life of arduous and faithful toil." He died on 
July 3, 1877, aged 80 years. He received the de- 
gree of LL.D from Princeton College in 1852. He 
contributed freely to medical literature, and was 
the author of several medical works, the most im- 
portant of which were "Memoirs, Medical and 
Surgical, of Dr. Nathan Smith," with additions by 
the author, 1831 ; "Surgical Anatomy of the Arte- 
ries," 1830; "Fractures of the Lower Extremity 
and Use of Suspensory Apparatus," 1867, and 
"Legends of the South," 1869. An excellent, 
handsome and lifelike portrait of Professor Smith 
adorns the faculty room of the medical school, and 
also a portrait, taken at a later period of life, is a 
valuable possession of the Medical and Chirurgical 
Faculty of Maryland at their hall on Cathedral 
street. 



ABSTRACT OF AN ADDRESS ON THE 

LIFE OF PROF. HORATIO GATES 

JAMESON. M.D., CLASS 

OF 1 81 3. 

Delivered by Gen. Horatio Gates Gibson, U. S. A. 

The following article was compiled from two 
publications of Henry O. Marcy. A.M.. M.D.. 
LL.D.. of Boston. They relate to an eminent 
physician of Baltimore to whose memory, as Dr. 
Marcy writes, "scant justice has been given." 
With the exception of Dr. Quinan's book on "The 
Physicians of Baltimore*' and Dr. Cordell's "Med- 
ical Annals of Maryland," which I have not yet 
seen, it would seem that the resurrection of his 
fame is largely due to the Rev. E. O. Jameson in 
"The Jamesons of America," and to the sketches 
of Dr. Henry O. Marcy, both of Boston. Col. J. 
Thomas Scharf in "The Chronicles of Baltimore" 
does not even mention his name, although Dr. 



Jameson held prominent public positions. It is 
another illustration of the truth of the Scriptural 
axiom that "a prophet is not without honor save 
in his own country," and of another that Balti- 
more, like the rest of the world, "knows nothing 
of its greatest men." 

When a guest at the Maryland Club in 1855. 
and later, in 1882-83, the old men I met had never 
even "heard tell of him." I except Mr. Samuel 
Taggart, who lived near his son in 1855. at Alt. 
Washington. Had his profession been like mine 
— that of destroying life instead of saving life — 
what would have been his modicum of glory? 

I am deeply gratified, as his descendant, that 
Dr. Marcy, who never knew him and lived in a 
city remote from him, has restored the full meas- 
ure of my grandsire's fame, of which my native 
city has reason to be proud, as well as ready to do 
like honor to him as Washington has done to 
Hahnemann, of another coterie, and to Benjamin 
Rush, the first great American physician. If 
prominent citizens of Boston, which he never vis- 
ited, and of Philadelphia and New York deem him 
worthy of all honor, why should those of Balti- 
more, where he sojourned for nearly half a cen- 
tury, withhold their tribute of appreciation? 

The following is compiled from two publica- 
tions by Henry ( ). Marcy, A.M.. M.D., LL.D., of 
Boston, Mass.— "A Brief Sketch of One of Bal- 
timore's Greatest Men, Horatio Gates Jameson. 
M.D.," and "The Suture; Its Place in Surgery" 
— the latter from The Journal of the American 
Medical Association, January 16. 1909, Vol. LII. 
pp. 201-208, and the former from The Transac- 
tions of the Southern Surgical and Gynecological 
Association, igo6, and after the lapse of 54 years 
since the death of Dr. Jameson, may be of some 
interest to the medical and other citizens of Balti- 
more : 

Even Lord Lister of England, a man of wide 
erudition and research, was entirely ignorant of 
the work of a predecessor in this field ( surgery), 
to whom now I have the honor of calling your 
attention. This was the more natural since I 
suppose today our English friends will admit that 
they earlier shared with Sidney Smith in the feel- 
ing which he expressed when he satirically asked. 
"Who reads an American book?" 

In this goodly city of Baltimore, in the early 
period, there lived a surgeon who is entitled to 
monumental distinction and enduring fame — Dr. 
Hi 'ratio Gates Jameson, lie was a surgeon of 



THE HOSPITAL BULLETIN 



20 1 



distinction, although a general practitioner of 
medicine. His publications were not numerous, 
as adjudged by a modern standard, but be wrote 
an admirable treatise upon fevers, a book upon 
domestic medicine and was the editor of a medical 
journal for years. His conclusions were quite at 
variance with the accepted teachings of the day, 
but in the light of our present knowledge re-read 
would be considered fundamental and orthodox. 

The sources of information of a man so fa- 
mous are extremely meager, although men still 
living have him in memory. Our late friend, Dr. 
Gross of Philadelphia, was for a time his junior 
assistant, and Dr. Gouley of New York has re- 
cently written me. in an interesting way, of his 
personal remembrance of Dr. Jameson. 

One of the most recent and most interesting 
of medical publications is entitled "The Medical 
Annals of Maryland," by Dr. Eugene F. Cordell 
of Baltimore. I have availed myself of its pages 
in the preparation of this article. 

The profession is indebted to the really monu- 
mental scientific studies of Dr. Horatio Gates 
Jameson of Baltimore, one of the leading surgeons 
of the period. His experimental studies were in 
a very large measure duplicated by Lord Lister 
a generation later. There is abundant evidence 
that Dr. Jameson was a singularly clean surgeon. 
His basis studies were made on various animals, 
and nearly all the wounds were evidently un- 
affected, since primary union was decidedly the 
rule. I have been at large pains to follow in de- 
tail the history of this extraordinary man as a 
surgeon, and I judge from his reports that it was 
the exception that suppuration ensued in his oper- 
ations. 

Few men did so much to give credit to early 
American surgery as Dr. Jameson, who, from 
1820 to 1840, carried the fame of Baltimore as a 
seat of medical and surgical research to all parts 
of the civilized world. This truly great surgeon 
was born in York, Pa., in 1778. His father, David 
Jameson, also a physician, had a most interesting 
and adventurous career. A native of Scotland 
and a graduate as doctor of medicine at the Uni- 
versity of Edinburgh, he emigrated to Charleston, 
S. C. about 1740. He was accompanied by Dr. 
Hugh Mercer, who settled at Fredericksburg, Va., 
and became a brigadier-general in the Continental 
Army, losing his life, as is well known, at the bat- 
tle of Princeton, in 1777. (One record of General 
Mercer gives the vear of his emigration to Amer- 



ica as 1747, two years after the Battle of Culloden. 
in which he participated as a follower of Bonnie 
Prince Charlie. This makes it probable that 
David Jameson was his comrade of battle as well 
as compagnon de voyage to America, although 
the family tradition, as remembered by me, does 
not mention the incident, and yet it is not impos- 
sible that both escaped the fate decreed by the 
curse of Scotland — the famed nine of diamonds). 

Dr. David Jameson removed from Charleston, 
S. C, and settled at York, Pa. He died at Ship- 
pensburg, Pa., after the close of the (eighteenth) 
century. (There is a church record of a daughter 
born to him in York in the year 1800). He was 
(an ensign and captain) in the French and Indian 
War (of 1755, and with the rank of lieutenant- 
colonel as late as 1769), and in 1755 w r as badly 
wounded in an engagement with Indians. (Just 
a century later his great-grandson was severely 
wounded in an encounter with the Indians of 
the Rogue River region of Oregon — in 1755 un- 
trodden by the white man). During the Revolu- 
tion he was colonel of the Third Battalion of the 
York County Association (militia). In 1S42 the 
son gave a charming description of his home at 
York in a Baltimore periodical (the American 
Record, which succeeded the Baltimore Clipper) : 
also an account of his father's voyage across the 
Atlantic, describing among its hardships the short 
allowance of musty bread and foul water and 
rusty salt beef doled out, yet consumed by pas- 
sengers and crew with avidity. 

Dr. H. G. Jameson studied medicine under his 
father, and began practice in 17Q5, at the early 
age of 17. (In 1707. at the age of 19, he married, 
at Somerset, Pa., Catherine Chevelle. a native of 
Alsace, then a provine of France, and renowned 
for the beauty of its women, and who died in Bal- 
timore in November, 1837. He settled in Balti- 
more about 1S10. and had two sons born to him 
there — Dr. David Davis Jameson and Dr. Horatio 
Gates Jameson of Church Hill. Queen Anne's 
county, and of Mt. Washington, Md.. and five of 
his grandchildren that survived him ) . During 
the War of 1812 he held the office of surgeon to 
the United States troops at Baltimore, for which 
his widow (second wife) received a pension after 
his death. (After he established himself in Balti- 
more he took the course of medicine in the Uni- 
versity of Maryland, and was graduated in 1813. 
See Dr. Quinan's book.) He was physician to the 
city jail for several years ; from 1814 to 1835 be 



202 



THE HOSPITAL BULLETIN 



was surgeon to the Baltimore Hospital, and from 
1821 to 1835 he was consulting physician to the 
Board of 1 [ealth. 

In 1830, on special invitation, he visited Eu- 
rope, sailing by the packet running from Balti- 
more to Germany, and read before the Medical 
Section of the Society of German Naturalists and 
Physicians a paper on "The Noncontagiousness 
of Yellow Fever." lie was the only American 
delegate on this occasion, and the first American 
to attend these meetings, and felt deeply the honor 
of his position. His paper was read in transla- 
tion at the meeting, and was published on his re- 
turn in his journal. During his brief stay in Eu- 
rope of two months he traveled through varioufe 
European countries, staying longest at Copen- 
hagen, to the American representative at which 
city he bore dispatches from our Government at 
Washington. I About 1827 he founded the Wash- 
ington .Medical College in Baltimore. Dr. An- 
nan, and. I think. Dr. Dunbar, were two of his 
contemporaries and associates therein). In 1835. 
while on his return from Texas, where he had 
purchased lands, he received and accepted a chair 
and presidency in the Ohio Medical College at 
Cincinnati. His colleagues there were Drs. Gross, 
Drake. Rives and J. B. Rogers — the last his late 
colleague at Baltimore. (On Dr. Jameson's re- 
turn journey to Baltimore, by the upsetting of the 
stagecoach running between Wheeling and Cum- 
berland, his leg was badly broken, and when he 
reached Baltimore, some time after the accident, 
he was still on crutches I. He removed to (Cin- 
cinnati) with his family in October, 1835, and lec- 
tured during the ensuing session, i He remained 
there until some time in March. 1836, when, in 
consequence of the serious illness of his wife and 
her earnest desire to return to her old home in 
Baltimore, he gave up his positions in Cincinnati 
and returned to the former city and resumed prac- 
tice there. 

Early in 1855 he removed to his native town of 
York, and during a visit I from there connected 
with a republication of his work on cholera) to 
New York he was taken suddenly ill, and died 
August 24. 1855. aged 70 \ears. His remains 
were then taken to Baltimore and interred in the 
Baltimore Cemetery, corner of Gay street and 
Boundary avenue. 

Dr. Jameson was about 5 feet 10 inches in 
height, well built, erect and muscular, but not 
corpulent ; his head was covered with a sufficiency 



of snow-white hair ; his face was always clean 
shaven, his complexion florid and healthy, his face 
remarkably smooth and free from wrinkles, his 
eyes dark and piercing and surmounted by bushy- 
eyebrows. He retained his strength and power 
of endurance to the last. He wore heavy — re- 
markably heavy — gold spectacles. He dressed in 
black, wore a black tie and was very careful and 
neat in his appearance — no one ever saw him look 
untidy. He spoke German, ami was noted for 
his mechanical ingenuity. 

( The interpretations made by me are indicated 
by parentheses J. 

Washington, D. C, September 17, 1909. 



ITEMS 



The surgical staff of the Baltimore Eye, Ear and 
1 hroat I lospital gave a dinner Thursday. Novem- 
ber 11, 1909, to Dr. Samuel Theobald at the Uni- 
versity Club, in recognition of his services as a 
founder and laborer in the interests of that insti- 
tution. The occasion was the eve of Dr. Theo- 
bald's birthday, and a handsome loving cup bear- 
ing an appropriate inscription was presented to 
him. The presentation address was made by Mr. 
Charles J. Bonaparte, a member of the board of 
managers of the hospital. Short addresses ex- 
pressing appreciation of Dr. Theobald's work 
were made by Mr. William l'.owlv Wilson and 
Drs. Johnston, Hartman, Friedenwald and H. O. 
Reik. 



Dr. Norman Dudley, class of 1901, of Church 
Hill, Md., was elected a delegate of the Queen 
-Anne's Medical Society to the Medical and Chi- 
rurgical Faculty at the annual meeting- of the so- 
ciety, held in Centreville, Md., November 12, 1909. 



Dr. Albert II. Carroll, class of 1907, of Balti- 
more, who had contemplated studying abroad, will 
remain at home durinsr the winter. 



Dr. A. C. Smink, class of 1896, who has lived 
and practiced medicine for the past 10 years at 
Woodlawn, Md., has moved into his new home at 
Norwood and Liberty Heights avenue, West For- 
est Park. 



The departments of law, dentistry, pharmacy, 
medicine and arts (St. John's College. Annap- 
olis) are arranging through a joint committee for 
a large college dance to be held at Lehmann's 



THE HOSPITAL BULLETIN 



2' >3 



Hall on Thursday, December 16, 1909. This is a 
move in the right direction, and marks another 
milestone in the welding of the various and hetero- 
geneous elements of the University into one school 
instead of a collection of more or less independent 
departments. The formation of the General 
Alumni Association in 1903 was the first evidence 
that the Celestial authorities of the University of 
Maryland were really waking up; the next sign, 
the joint commencements of the several schools; 
the third, Academic Day; the fourth, an apparent 
arousing of the Board of Regents to the realization 
that they are concerned with the government of the 
institution, and fifth, the prospective ball, which is 
the first joint student affair ever held under the 
name of the University of Maryland. The Bul- 
letin congratulates those in charge of the affair, 
and wishes them much success. The committee 
on arrangements consists of Messrs. Archey C. 
Xew, chairman ; S. L. Bachrach and Harry F. 
Ogden of the law department ; Frank P. Fiery, 
James E. Talbott and George S. Condit, of the 
medical; Charles D. Aiuslie, Walton Graft and 
Thomas D. Webb, of the dental, and H. E. Wilson, 
E. R. Hauver and R. P. Hartle, of St. John's 
College. 



Alexander Crever Abbott, class of 1884, was 
born in Baltimore, February 26, i860. After 
graduating he was appointed assistant in bacteri- 
ology and hygiene, Johns Hopkins University 
(1889-1891). From 1891 to 1896 he was first 
assistant, laboratory of hygiene, University of 
Pennsylvania. Since 1896 he has been director 
of laboratory of hygiene and professor of hygiene, 
University of Pennsylvania. In 1897 he was nom- 
inated as director of laboratory of hygiene, Bu- 
reau of Health, Philadelphia. He is the author 
of the "Principles of Bacteriology and Hygiene ' 
of Transmissible Diseases." In 1907, during the 
centennial exercises, he was given the honorary 
degree of Doctor of Science by his Alma Mater. 
Dr. Abbott has been a credit to the University of 
Maryland, and is a well-wisher for its present and 
future success. He says that the best interests of 
the University would be subserved by an inde- 
pendent board of trustees, and is of the opinion 
that we will not attract any large benefactions 
until the management of the affairs of the institu- 
tion is entrusted to a disinterested bodv. 



born at Hampden, then in Baltimore county, on 
August 31, 1873. For some time after graduating 
he was a surgical assistant in the dispensary of 
the University Hospital. From 1896 to 1898 he 
held the position of sanitary inspector for the city 
of Baltimore. Since 1898 he has been a surgeon 
for the Pennsylvania Railroad. Dr. Algire lives 
in Hampden, at present a suburb of Baltimore, 
where he enjoys the confidence of a large clientele. 



Dr. Edward Anderson, class of 1875, is a native 
of Rockville, Md., where he has been engaged in 
the practice of his profession more than 30 years. 
Since 1892 he has been a member of the Medical 
and Chirurgical Faculty. He is also a member of 
the American Medical Association. Some years 
ago he was president of the Montgomery County 
Medical Society. In 1889 he was elected physi- 
cian of the Montgomery County Almshouse, and 
has served in that capacity to the present time. 
He is a frequent contributor to the medical period- 
icals upon subjects pertaining to medicine and 
surgery. Dr. Anderson was born May 3, 1841. 
He is a son of James W. Anderson and Mary 
Miner Anderson. Fie is of distinguished Scotch- 
English ancestry. Dr. James Anderson, his 
grandfather, was a soldier in the American Army 
in the Revolution, and one of the founders of the 
Medical and Chirurgical Faculty. Dr. Edward 
Anderson received his preliminary education at 
Rockville Academy. In 1874 he matriculated in 
the medical department of the University of Mary- 
land, whence he was graduated in 1875 with the 
degree M.D. After graduating he at once entered 
general practice in his native town, Rockville, 
where he has taken a prominent position in his pro- 
fession. In 1883 he married Mrs. Alice Thomp- 
son, widow of Dr. Benet Thompson of Washing- 
ton, D. C, and daughter of J. J. Lawn of Balti- 
more, by whom he has one son, Edward Ander- 
son of Washington, an employe of the Interior 
Department. 



Dr. William S. Archer, class of 1880, an A.B. 
and A.M. of Princeton, is located at Belair, Md. 

Dr. Charles D. Baker, class of 1881, is located 
at Rohrersville, Washington county, Maryland. 



Dr. Harry Cairnes Algire, class of 1895, was 



Dr. John Barron, class of 1887, of Govanstown, 
Md., is a native of Ireland, where he was born 
March 26, 1843. I' 1 T &45 he emigrated to the 



204 



THE HOSPITAL BULLETIN' 



United States. He receive his literary education 
at Loyola College, Baltimore, and St. James Insti- 
tute, Philadelphia, and his medical at the Univer- 
sity of Maryland. After practicing in Philadel- 
phia and Baltimore he located permanently at 
Govanstown, where he still resides. 



Dr. Guy Asper, class of 1903, of Chambers- 
burg, Pa., has been confined to the University 
Hospital with middle-ear trouble. 



Dr. Walter Franklin Weber, class of 1909, is 
confined to the University Hospital with an affec- 
tion of the kidnev. 



Dr. 'William Russell Rogers, class of 1901. of 
Bristol, Ya.. paid a flying visit to the University 
Hospital recently. 



Dr. John A. Gibson, class of 1901, of Leesburg. 
Ya., was in town recently, and reports that he is 
doing well in the practice of his profession. 



Dr. William Fulford Sappington, class of 1901, 
of Websters Mill, Pa., recently paid the Univer- 
sity Hospital a visit. He is the same old Sapping- 
ton as in student days. We are glad to announce 
that Dr. Sappington has done well in practice. 



Dr. Charles W. Famous, class of 1901, of Har- 
ford county, Maryland, was a recent visitor to the 
University Hospital. 



Amongst others seen around the corridors of 
the University Hospital recently was Dr. W. S. 
Maxwell, class of 1873, of Still Pond, Md. 

Dr. Fred Clifton Moor, class of 1903, of Talla- 
hassee. Fla.. whilst in town visited his old friends 
at the University Hospital. 



Dr. Charles Edward Terry, class of 1903, Jack- 
sonville, Fla., owing to eye trouble, has been com- 
pelled to cease all active work for a time. When 
in Baltimore recently he said that they were im- 
proving, and that he has hopes of being able to 
engage in internal medicine in the near future. 
The editors of the Bulletin desire to here express 
their sympathy to Dr. Terry, and sincerely wish 
that in the very near future his sight will be en- 
tirely restored. Dr. Terry was an excellent stu- 
dent when in the U/niversitv, and was universally 



popular with his classmates. After graduating 
he settled in Jacksonville, where he had succeeded 
in building up a profitable practice. 



Dr. Jacob Wheeler Bird, class of 1907, of Sandy 
Spring, Md., is a frequent visitor to the University 
Hospital. 



Dr. C. P. Carrico of Cherry Hill presided at 
the fall meeting of the Cecil County Medical So- 
ciety, held at Elkton November 11, 1909. 



The following of our alumni are upon the sur- 
gical staff of the Hospital for the Women of Mary- 
land : Drs. Chas. Riley, Samuel T. Earle, Robert 
Wilson, J. Mason Plundley, George W. Dobbin 
and A. C. Harrison. This institution, which is 
located at Lafayette avenue and John street, has 
just completed a new $75,000 addition. The hos- 
pital was organized in 1883 by Drs. William T. 
Howard, Henry P. Wilson and Charles Riley. 
The two operating-rooms are being erected to the 
memory of Drs. Wilson and Howard. 



Dr. Thomas H. Buckler, class of 1888, has re- 
signed the presidency of the Paint and Powder 
Club of Baltimore, a position he has held four 
vears. 



Dr. Morris Ramsey Bowie, class of 1908, is 
located at Paonia. Colo. 



At the annual meeting of the Nurses' Alumnae 
Association of the University Hospital, held De- 
cember 6, 1909, the following were elected to office 
for the ensuing year : 

President — Mrs. Page Edmunds. 

First Vice-President — Miss Alice F. 

Second Yice-President — Miss M. E. 

Secretary — Miss B. C. Weitzel. 

Treasurer — Mrs. Nathan Winslow. 

First Member— Miss M. E. Rolph. 

Second Member — Miss M. E. Lawrence. 



Bell. 
Elgin. 



Dr. James II. Jarrett, class of 1852. a well- 
known physician of Towson. who is recovering 
from an attack of indigestion and vertigo, is able 
to be in his office again, and expects in the near 
future to be out. Dr. Jarrett is 78 years old, and 
has been practicing for 58 years. During the Civil 
War he served as a surgeon in the Seventh Mary- 
land Regiment, Union Army. Before the war he 



THE HOSPITAL BULLETIN 



205 



was a member of the Maryland Legislature from At the meeting of the Section on Neurology 

Harford county. Mis brother. Dr. Martin L. Jar- any Psychiatry, Baltimore City Medical Society, 



rett, class of 1864, was elected to the Legislature 
from Harford county at the recent election. Dr. 
Jarrett is a member of Wilson Post, Grand Army 
of the Republic; the Union Veteran Association 
and the Baltimore County Medical Society. 



The engagement of Miss 1!. C. Weitzel, a grad- 
uate of the University Hospital Training School 
for Nurses, and active member of the Nurses' 
Alumnae* Association, to Mr. Charles H. McNabb, 
a rising young lawyer of Belair, Md., has been 
announced. Air. McNabb is a graduate of St. 
John's College, Department of Arts and Sciences. 



Dr. FitzRandolph Winslow has taken an office 
at the corner of Lombard and Monroe streets, 
Baltimt ire. 



Dr. Randolph Winslow will read a paper on 
"Acute Abdominal Conditions in Infants" at the 
coming meeting of the Southern Surgical and 
Gynecological Association at Hot Springs, Va. 



Dr. Martin Bruns. Dr. N. M. Owensby, Dr. 
Frank Keating and Dr. William F. Swartz at- 
tended the last meeting of the Psychiatric Society, 
held at Hay view Hospital. 

Drs. A. Duvall Atkinson, John T. O'Mara anil 
Henry J. Hahn have been appointed visiting physi- 
cians to St. Agnes' Hospital ; Drs. St. Clair Spruill, 
J. Mason Hundley and A. M. Shipley, visiting 
surgeons ; R. Tunstall Taylor, visiting orthope- 
dist. 



The regular meeting of the University of Mary- 
land Medical Society was held in the amphitheater 
of the hospital Tuesday, November 16, 1909, at 
8.30 P. M. The entire evening was devoted to a 
discussion of hookworm disease. The program 
was as follows : 

i . Hookworm Disease, Dr. Harry Adler. 

2. Discussion, Dr. W. H. Smith and Dr. J. W. 
Holland. 



The General Alumni Association held its fall 
meeting on Wednesday evening, November 10, 
1909. at Davidge Hall. Judge Duncan of Balti- 
more county made an excellent address upon the 
duties and obligations of a county judge. 



November 12, 1909, papers were read by Drs^ 
Irving J. Spear, R. P. Cay and R. Martin Bruns. 



Dr. and Mrs. Nathan R. Gorter are spending a 
few davs at Atlantic City. 



Dr. George 1. White, class of 1890, of Marion, 
N. C. who has been a patient at the University 
Hospital, has so far improved as to be able to leave 
fur In ime. 



A special service was held in Westminster 
Presbyterian Church Sunday, November 21, 1909. 
under the auspices of the Young Men's Christian 
Association of the University of Maryland. A lay 
sermon was delivered by Dr. John C. Hemmeter 
on "Religion and Scholarship, or Divine Knowl- 
edge and Human Knowledge." The music was in 
charge of Miss Lena Steibler of the Peabody In- 
stitute, assisted by the Westminster choir. The 
musical program included solos by Miss Imo 
Thompson. .Miss Elizabeth Leckie, Miss Rose 
< larrett and Miss Steibler. 



The University of Maryland has asked the State 
Board of Charities to recommend to the Legisla- 
ture an appropriation of $4000 yearly to this insti- 
tution. 



Dr. John S. Fulton, class of 1881. was 
elected a member of the executive committee of 
the American Association for the Study and Pre- 
vention of Infant Mortality at its meeting held in 
New Haven, Conn.. November 13. 1909. 



MARRIAGES 



Dr. William Ellicott Tyson, class of 1905, was 
married Saturday afternoon, November 27, 1909, 
in Washington, District of Columbia, to Miss 
Elizabeth McPherson Weems, daughter of Mr. 
and Mrs. Juan Crampton Weems. Dr. Tyson was 
for a time resident physician in the maternity de- 
partment of the University of Maryland; later a 
resident physician in the Women's Hospital, Ken- 
sington, Philadelphia, Pa., and now a resident of 
Detroit, Mich. The nuptial knot was tied by Rev. 
Thomas Alexander Johnstone, rector of St. Phil- 
lip's Church. Laurel, Md. The ceremony took 



THE HOSPITAL BULLETIN 



place at the home of the bride's parents, 1727 
19th street. Washington, District of Columbia. 
The bride was attended by her sister, Mrs. Water- 
man Allen Taft. of Boston, as matron of honor, 
and another sister. Miss Frances Weems, wa« 
bridesmaid. Dr. Riddon Dees of Greensboro, N. 
C, was best man. After the ceremony Dr. and 
Mrs. Tyson left for a trip North, and will be at 
home in Detroit on the first of the new year. The 
bride is a granddaughter of the late John D. Mc- 
Pherson of Ever May, Georgetown. Her father 
is a grandson of the late John C. Weems of Loch 
Eden, West River. Maryland. The bridegroom is 
a member of the Tyson and Ellicott families of 
Maryland. 



Dr. Robert Levis Mitchell, class of 1905, an 
ex-resident gynecologist to the University Hos- 
pital, and at present an assistant in the gyneco- 
logical department of the dispensary of the Uni- 
versity Hospital, an ex-houseman, and in his stu- 
dent days a member of the football team, also a 
graduate of the department of pharmacy, was 
married Wednesday, November 17. 1909, in the 
Presbyterian Church at Elkton, Md., to Miss 
Annie Inskip Smith, daughter of Mr. and Mrs. 
William Bass Smith, of Elkton. After their 
honeymoon Dr. and Mrs. Mitchell will make their 
home in Baltimore. 



Dr. John Robert Paddison, class of 1902, of 
Oak Ridge, N. C, and Miss Zora Sapp of Kerners- 
ville, N. C, were married at St. Leo's Hospital in 
Greensboro. N. C, October 28, 1909. The cere- 
mony was performed immediately preceding an 
operation for appendicitis which Dr. Paddison 
underwent successfully. 



Dr. Edwin Ferebee Fenner, a young physician 
of Henderson, N. C. and Miss Louise Sampson of 
Manchester. Ya., were married in the Presbyterian 
Church of that city on the evening of October 20, 
19/39. Dr. Fenner is a graduate of the University 
of Maryland, having graduated from this institu- 
tion in the spring of 1905. He is a popular physi- 
cian of Henderson, and has many friends there as 
well as throughout the State. 



Dr. Peter McLean, a prominent young physician 
of Laurinburg. N. C. and Miss Alice Lee Elliott 
were married at the bride's home on Little River. 
North Carolina, on October 30, 1909. Dr. Mc- 



Lean graduated from the medical department of 
the University of Maryland in 1906, since which 
time he has been a very successful practitioner. 
He received his license to practice medicine in 
1907 and joined the North Carolina Medical So- 
ciety in 1 90S. 



Dr. Preston G. Hundley, class of 1909. of West 
Virginia, was married Wednesday, November 24, 
1909, to Miss Mary E. Lyell. only daughter of Mr. 
John M. Lyell of Richmond. Va., at Brantlv Bap- 
tist Church. Baltimore, by the pastor, Rev. Dr. PI. 
M. Wharton, assisted by Rev. John T. Hundley 
of Norfolk, Va., a brother of the groom. Imme- 
diately after the ceremony Dr. and Mrs. Hundley 
left for a wedding journey South, and will live in 
West Virginia. 



Mr. William Ebert, class of 1912, and Miss 
Louise Bowly of Baltimore were married Septem- 
ber 29 at Wilmington, Del. 



DEATHS 

James Wells Herbert, class of 1871, for several 
years apothecary at the Marine Barracks, Wash- 
ington. District of Columbia, and prior to that time 
surgeon to the United States Steamship Lancaster, 
died at his home in Washington September 5 of 
paresis, aged 59. 



Dr. Levin Gillis Owings, class of 1900. of Elli- 
cott City, Md., a young and promising physician 
of Howard county, died at the home of his father. 
L. I. T. Owens, at Ruxbury Mills, of tuberculosis. 
Dr. ( twins had been in failing health for two years. 
At the onset of his sickness he went to the Adiron- 
dacks in search of health, but was not benefited, so 
returned home, where he remained until the day 
of his death. Dr. Owings was a son of ex-County 
Commissioner Owings, and was a graduate of 
Western Maryland College, and the medical de- 
partment of the University of Maryland. After 
graduating Dr. Owings was an interne in the 
University Hospital on the medical side for a year. 
He then went to Ellicott City, where he opened an 
1 iffice. He was engaged in active practice until 
two years ago. when his health became such as to 
force him to forego further work. Besides his 
father, he is survived by two sisters. Misses Ruth 
and Minnie Owings, and one brother, Mr. Thomas 
1 Iwings, of Montgomerv countv, Marvland. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 
PRICE #1.00 PER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. V 



BALTIMORE, MD., JANUARY 15, 1910. 



No. 11 



RELIGION AND SCHOLARSHIP; OR, 

DIVINE KNOWLEDGE AND HUMAN 

KNOWLEDGE. 



A Lav Sekmon by John C. Hem me tick, 

M.D., Ph.D., LL.D., 

Professor of Physiology and Clinical Professor of 

Medicine in the University of Maryland. 



Delivered by invitation of the Young Men's 
Christian Association of the University at 
Westminster Presbyterian Church, 
Baltimore, Sunday, Novem- 
ber 21, I909. 

INTRODUCTION. 

When a man of learning becomes a disbeliever 
there is exultation among the skeptics and athe- 
ists. "Behold the fruits of the highest intellectual 
culture!" they cry. "Behold, the result is the 
turning away of man from God !" And then fol- 
lows the enumeration of all men of great intellect 
who have been agnostics or atheists. Notably 
around Charles Darwin does the polemic of dis- 
believers wage most fiercely, for in the "Life and 
Letters of Charles Darwin" by his son, Francis D., 
we gain an insight into the process of getting lost 
in disbelief of the eminent naturalist. On p. 278 
of Vol. I of this work we learn that there were 
chiefly two reasons for this skepticism — ( 1 ) the 
incredibility of the miracles by which he assumes 
Christianity is supported, and (2) that the old 
argument from design in nature as given by 
Paley which "formerly seemed to him conclusive" 
failed now that the "law of natural selection" had 
been discovered. Opposed to the first of these 
reasons are the words of the founder of Christian- 
ity Himself, that He did not intend that His re- 
ligion should be founded on miracles (John iv, 
48; Matthew xii, 38 and 39). It is, therefore, a 
fundamental error when this great thinker as- 
sumes (in his "Autobiography," written in 1876) 
that Christianity needs the support of miracles. 
Darwin, as the father of the law of natural selec- 



tion, was led to think more and more objectively, 
and confesses that as he lost interest in music and 
poetry, so he forgot how to think spiritually. The 
father of a new direction of human thinking nat- 
urallv becomes disinclined to agree with any doc- 
trine that is seemingly at variance with the new 
law he has discovered. This feeling of antag- 
onism to anything that tended to oppose his men- 
tal offering was to be expected. // zvill always be 
strange that it should be thought the safest course 
to separate as sharply and as widely as we can 
between that which we are called upon to believe 
in religion and that which we arc able to trace or 
understand in nature. 

< Hie of the profoundest arguments in the entire 
range of Christian philosophy is presented by 
Butler in his "Christian Analogy" concerning this 
apparent antithesis between religious faith and 
faith in science. All the steps of the argument of 
Butler are founded on the opposite belief, namely, 
that all the truths, and not less all the difficulties, 
of religion have their type and likeness in the con- 
stitution and course of nature. This reasoning is 
as profound as it is simple, and as we follow it 
our eyes are ever and anon opened to some new- 
interpretation of familiar facts, and we gradually 
learn to recognize among the curious things of 
the earth one after another of the laws which, 
when told us of the spiritual world, seem so per- 
plexing and so hard to understand. 

Concerning the argument that the discovery of 
the law of natural selection had invalidated the 
belief in purpose and design, in the results and 
methods of creation, this has been completely an- 
swered by the Duke of Argyle in his "Reign of 
Law" (see this book and Note A to p. 46) ; also 
his discussion with Mr. Wallace in the Journal of 
Science. No. 16, October, 1867. After reading 
these able discourses I believe every evenly bal- 
anced mind will feel satisfied that between the 
scientific conception of the law of natural selec- 
tion and the religious conception of purpose or 
design in creation there is no conflict. 



208 



THE HOSPITAL BULLETIN 



Mr. Wallace virtually admits that it dwindles 
down to this : "It is simply a question of how the 
Creator has worked." But if we desired any fur- 
ther harmonizing of these apparent discrepancies 
between fundamental scientific and fundamental 
religious opinions we find them in Henry Drum- 
mond's work on "Natural Law in the Spiritual 
World." 

In this connection I feel it my duty to call at- 
tention to the modern tendency of some of the 
most prominent representatives of natural science 
to become dogmatic. Dogmatism, which by 
Haeckel, Huxley and others was asserted to be 
the exclusive possession of religious people, is fre- 
quently observed in scientific arguments, whilst 
it is claimed with equal firmness that open-minded 
intellectual integrity and courage are the charac- 
teristics of those that reject Christianity. Accord- 
ing to Lyman Abbott, a man of great intellectual 
distinction who counted himself an agnostic said 
not long ago of an equally distinguished man 
who was an ardent Christian : "I don't see how 
it is possible for so able a man to believe the fain- 
tale of Christianity. He cannot be entirely sin- 
cere." This assumption that a person of superior 
intelligence must be a skeptic overshadows the 
faith of many good people. The remark quoted 
is very similar to those I have personally heard 
during conventions of scientific men in this coun- 
try and abroad, where it occasionally becomes evi- 
dent that among those who lay great claim to lib- 
eralism there are a surprising number who are 
conspicuous for narrowness and dogmatism. 

The assumption of the intellectual superiority 
of the skeptic over the adherent to faith is born 
of pure arrogance. It has no authority to chal- 
lenge belief as if it were the sole custodian of 
truth. In the following sermon on the interview 
of Christ with Nicodemus I shall endeavor to 
make clear the particular susceptibility of learned 
men to lean too much toward objective evidence 
and to lose the spiritual side of their natures, and 
even to suggest that faith rests solidly on the 
largest and most courageous use of reason, by 
which I mean the full play of all the human facul- 
ties, the complete exercise of human knowledge. 

In one of the most masterly and scholarly con- 
tributions to this subject Josiah Royce says (Har- 
vard Theologic Revieiv, October 1909, p. 434, 
"What Is Vital in Christianity?"): "The world 
of our usual human experience is but a beggarly 
fragment of the truth, and if we take too serious- 



ly the bits of wisdom that it enables us to collect 
by observation of special facts and of natural laws 
it becomes a sort of curtain to hide from us the 
genuine realm of spiritual realities in the midst 
of which we all the while live." 

The effort to found a new religion on the basis 
of natural law as revealed and understood by 
human intellect has been made many times and 
long before the scholarly attempt by Dr. Charles 
Eliot, the erudite ex-president of Harvard Uni- 
versity {Harvard Theologic Review, October, 
1909, p. 389). But laws (see Duke of Argyle on 
the "Reign of Law") do not explain anything ex- 
cept the order of subordinate phenomena in na- 
ture. They set forth that order as due to force ; 
they do nothing more. They do not explain the 
force of which they are the resultant. 

Least of all do laws explain themselves. They 
suggest a thousand questions much more curious 
than the questions they solve, or, rather, attempt 
to solve. The very beauty and simplicity of some 
laws is their deepest mystery. What can their 
source be? How is their uniformity maintained? 
All that we ever know is some numerical rule or 
measure according to which some unknown 
forces operate. But whence come those measures 
we are not told. They are the result of human 
speculations, of the operation of our senses. But, 
unlike the ordinary consciousness, the religious 
consciousness is concerned with that which lies 
beyond the sphere of sense. 

The unreliability of a religion that is based on 
what human beings recognize as "natural law" is 
evidenced by the errors our sense faculties have 
been shown to exhibit. The views of today — say 
of the constitution of matter and the laws of 
Keppler and Newton that hold matter together — 
may appear satisfactory to us for the present, 
but how will these laws be regarded by the phys- 
icist at the end of the twentieth century? Ac- 
cording to Faraday and Sir William Crookes, we 
are incessantly learning the lesson that our re- 
searches have only a provisional value. 

The view of Crookes ("President's Address to 
British Chemical Society," March, 1880) that all 
of our chemical elements have been formed from 
one primordial substance is gaining ground 
among physicists, and with it the view that all 
matter now existing is disintegrating at almost 
immeasurably slow rate and reverting to the state 
of this single primordial element, which he terms 



THE HOSPITAL BULLETIN 



209 



protyle. The rate of this disintegration is ex- 
pressed by Becquerel in his calculation, in which 
he believes to have shown that one square centi- 
meter of radioactive surface would radiate into 
space one gram of matter in one billion years, or, 
according to Crookes, if one million atoms fly off 
every second it would require a century to 
diminish one milligram. This fatal quality of 
atomic dissociation appears to be universal, not 
only in radium, where it is most active, but in all 
matter. It operates whenever a piece of glass is 
rubbed with silk in the ordinary friction machine, 
it works in the sunshine and rain drops, and in the 
lightning and flame, it prevails in the waterfall 
and stormy sea. and although the whole range of 
human experience is all too short to afford a 
parallax whereby the date of the extinction of 
matter can be calculated, protyle — the formless 
mist, the primordial mother substance of all mat- 
ter — once again may reign supreme, and the hour 
hand of eternity will have completed one revolu- 
tion. 

"If thou wouldst know the mystic song 
Chaunted when the sphere was young, 
Aloft, abroad, the pean swells — 
O wise man, hearest thou half it tells? 
To the open ear it sings 
The early genesis of things ; 
Of tendency through endless ages 
Of star dust and star pilgrimages. 
Of rounded worlds, or space and time, 
Of the old flood's subsiding slime, 
Of chemic matter, force and form, 
Of poles and powers, cold, wet and warm ; 
The rushing metamorphosis 
Dissolving all that fixture is, 
Melts things that be to things that seem, 
And solid nature to a dream." 

■ — Emerson. 

These are examples of the imaginings of some 
of the foremost physicists, and upon such specu- 
lations it is suggested a religion could be founded 
— as possibly it could. But if natural laws as we 
formulate them are based either on speculation or 
research, and if both of these have only a pro- 
visional value, the question is justifiable, What 
enduring power can a religion have that is built 
upon such human endeavors? Harnack ("What 
Is Christianity?") states a truth of enormous pen- 
etration when he declares that it was one of the 
enduring qualities of religion of Christ that noj 



effort was made to found it upon science — in the 
first place, because the domains of religion and 
science are entirely different, and, secondly, be- 
cause a religion that would have to change its 
foundation as often as science has already done 
could not inspire the confidence of a Divine reve- 
lation. 

In elaborating on the following quotation from 
the third chapter of John, I lay no claim to origi- 
nality in the manner in which the subject is 
treated. I can only say that having heard it 
treated in that way by Consistorialrath E. Only 
of Wiesbaden and Dr. Frederick Lynch of New 
York, I am quoting largely as I remember their 
sermons : 

"There was a man of the Pharisees, named 
Nicodemus, a ruler of the Jews. The same came 
to Jesus by night, and said unto Him : 'Rabbi, we 
know that Thou art a teacher come from God: 
for no man can do these miracles that Thou doest 
except God be with him.' Jesus answered and 
said unto him : 'Verily, verily. I say unto thee, ex- 
cept a man be born again be cannot see the king- 
dom of God.' Nicodemus saith unto Him : 'How 
can a man be born when he is old? Can he enter 
the second time into his mother's womb and be 
born?' Jesus answered : 'Verily, verily, I say unto 
thee, except a man be born of water and of the 
spirit he cannot enter into the kingdom of God. 
That which is born of the flesh is flesh, and that 
which is born of the spirit is spirit. Marvel not 
that I said unto thee, ye must be born again. The 
wind bloweth where it listeth, and thou hearest 
the sound thereof, but canst not tell whence it 
cometh and whither it goeth ; so is everyone that 
is born of the spirit.' Nicodemus answered and 
said unto Him : 'How can these things be?' Jesus 
answered and said unto him: 'Art thou a master 
of Israel and knowest not these things? Verily, 
verily, I say unto thee, we speak that we do know, 
and testify that we have seen ; and ye perceive not 
our witness. If I have told you earthly things, 
and ye believe not, how shall ye believe if I tell 
you of heavenly things?" — John iii, 1-12. 

FIRST EARTHLY THINGS, THEN HEAVENLY. 

It is much to be regretted that more of the con- 
versation of Jesus with scholars of His day and 
with strangers have not been recorded, for in 
these familiar talks He said some of His greatest 
Sand most far-reaching things. Here in this 
■formal conversation with Nicodemus He uttered 



2IC 



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the foundation truth of religion, namely, the Di- 
vine spirit of God reaching down and lifting men 
up into the kingdom of heaven. That is the be- 
ginning and end of religion. This conversation 
is especially interesting because it is with a 
scholar, and Jesus had very little contact with the 
educated men of Israel. Nicodemus was a learned 
lawyer and was very much interested in religious 
questions, particularly their intellectual and politi- 
cal aspects. He had, doubtless, as the chief de- 
sire of his life, the restoration of the kingdom of 
Israel. Stirred by his prophetic books, he was 
eagerly watching for signs of its approach. John 
the Baptist's preaching, that it was near, may 
have awakened in him renewed expectancy. Any- 
how, he eagerly follows Jesus and becomes in- 
tensely excited over His deeds and words. As 
soon as night comes, when he can find Jesus 
alone, he seeks Him, and then ensues one of the 
most interesting conversations ever held. Of 
course, we have only a fragment of their talk. 
Perhaps they talked long into the night. But we 
have enough of outline to reconstruct it. 

Nicodemus says to Jesus that he has heard Him 
preach, and, although much interested, could not 
understand His teaching; but he was very much 
impressed by His miracles, and knows that He 
must have come from God and that God is with 
Him, otherwise He could not do those wonderful 
things. Then Nicodemus must have told Jesus 
that He was just the man to take hold of the Jew- 
ish people and gather Israel about Him and es- 
tablish the kingdom, set the church on its old 
foundations and bring back the departed glory of 
Zion. 

Then Jesus must have spent a long time in dis- 
abusing Nicodemus' mind of this false idea of the 
kingdom, showing him its real nature — how it 
was an inward kingdom, independent of States 
or churches, strength or weakness, riches or pov- 
erty ; how it was a state of being, a disposition, a 
communion with God, the eternal life. 

Nicodemus listens absorbedly, but at last ex- 
claims: "It is beautiful, wonderful, but I cannot 
understand, I cannot see it." 

Then Jesus utters the one great secret of all 
spiritual living — "Except a man be born anew, 
born from above, he cannot see the kingdom of 
God." 

But all this was utterly outside Nicodemus' ex- 
perience, and he vaguely shakes his head and 
says: "How can an old man be born again?" 









Then Jesus repeats and explains: "Except 
man be touched and awakened from above by tl 
Spirit of God he cannot find the way into the 
kingdom. That which is born of flesh is flesh, and 
can comprehend only fleshy things; that which is 
born of the Spirit is spirit, and can comprehenc 
the things of the spirit. Just as the wind roam 
over the earth, doing its mysterious work, anc 
man can only wonder and have no power over 
so the Spirit of God touches the hearts of men 
the same mysterious way and works its holy won- 
ders in them." 

But Nicodemus had neglected his spiritual na- 
ture, and this is all foreign language to him. And 
Jesus is surprised and somewhat impatient, and 
exclaims: "Art thou a teacher of religion in 
Israel and know not the simple beginnings of re 
ligion ? If you have not believed and lived the 
simple earthly principles of cultivating the spir 
itual life and common virtues which you have 
heard Me teach, how can you understand and be- 
lieve if I tell you heavenly things?" Then Jesus 
goes on to explain His own relation to the king- 
dom. And late in the night Nicodemus goes 
home to ponder these things, and he ponders them 
to his redemption, as we shall see. 

This is about the way in which Consistorialrath 
< >hly and Frederick Lynch interpreted this fasci- 
nating discourse. Now as to our deductions. 

"Unlike the ordinary consciousness, the re- 
ligious consciousness is concerned with that which 
lies beyond the sphere of sense. A brute thinks 
only of things which can be touched, seen, heard, 
tasted, etc., and the like is true of the untaught 
child, the deaf-mute and the lowest savage. But 
the developing man has thoughts about existences 
which he regards as usually intangible, inaudible, 
invisible, and yet which he regards as operative 
upon him." 

So says Herbert Spencer. If this be true, then 
he who is more than a brute, who thinks some- 
times of what cannot be touched, seen, heard, 
tasted, etc., will be interested to know what one 
of the greatest religious teachers of the ages has 
to say about the one great Being who is intangi- 
ble, inaudible, invisible, and yet is operative in 
mankind. What does Jesus teach about God? 
And this question will interest the thoughtful 
man, whether or not he thinks that Jesus pos- 
sessed a Divine or even an exceptionally prophetic 
character. 






THE HOSPITAL BULLETIN 



21 1 



Herbert Spencer has said that nothing is more 
:ertain than that we are ever in the presence of 
an Infinite and Eternal Energy, from which all 
things proceed. At least twenty-odd centuries 
before Herbert Spencer an unknown Hebrew poet 
had said the same thing : 

"Whither shall I go from Thy Spirit? 
Or whither shall I flee from Thy presence ? 
If I ascend up into heaven, Thou art there ; 
If I make my bed in hell, behold, Thou art there ; 
If I take the wings of the morning 
And dwell in the uttermost parts of the sea, 
Even there shall Thy hand lead me, 
And Thy right hand shall hold me." 

What did Jesus teach concerning this intangi- 
ble, inaudible, invisible, yet universal Presence? 

First of all, that the "knowledge of God is not 
school knowledge ; it is life knowledge ; not infor- 
mation, but acquaintance." "God is not to be 
known by reasoning out doctrines of Him, but by 
living with Him." "A man is to know God as a 
child knows his parents — by experience." So, 
for the answer to the question. What did Jesus 
teach ? we are not sent merely to the Four Gos- 
pels. We are sent to the experience of the pupils 
of Jesus. What is the conception of God which 
has grown up in the experience of Christians out 
of the teaching of Christ ? Or, to turn back to the 
phraseology of Herbert Spencer, if the develop- 
ing man has thoughts concerning the invisible but 
universal presence, what are the thoughts of those 
who consciously owe their religious development 
to the teachings of Jesus Christ? 

Christians universally believe in a personal God. 
What do we mean by a person ? Why am I, I ; 
and you, you ? We mean consciousness and 
choice ; some knowledge of ourselves, and some 
power to direct ourselves, or, in more technical 
language, self-consciousness and self-determina- 
tion. In the experiences of all Christians, and in 
the teaching of Jesus that has come down to us, 
this is the first and most fundamental truth. This 
inaudible, invisible, universal Presence, this In- 
finite and Eternal Energy from which all things 
proceed, is one who is related to men, one between 
whom and men communion, fellowship, converse 
is possible. This Presence is "H e," not "It." Says 
Matthew Arnold : "Many excellent people are 
crying out every day that all is lost in religion un- 
less we can affirm that God is a person who thinks 



and loves." These many excellent people are 
right in so far as this : it is true that what is most 
fundamental in the Christian religion is lost un- 
less we can affirm that God is a person who thinks 
and loves. For the whole of the Christian re- 
ligion might be said to be summed up in the 
words, "Say, Our Father." For it all grows out 
of the faith that Christian experience is common 
to humanity — that is, religion is a common, and 
may be a universal, experience, and that it is an 
experience of conscious filial relation to the In- 
finite, who is never perfectly understood, but need 
never be unknown. Christianity does not ap- 
proach God as a Great First Cause — that is, 
through philosophy; it approaches Him as the 
Great Companion — that is, through experience. 

( >ne more illustration must suffice here to com- 
plete this hint as to a doctrine of God built out of 
human experience. What do we mean by the 
transcendence and what by the immanence of 
God? What is there in personal experience 
which answers to these phraseologies? Two 
truths of universal consciousness: I am more 
than the body which I inhabit, and it is subject to 
me — a truth which psychology may interpret or 
explain, but can never successfully controvert. 
But I am also equally present in all parts of my 
body, and in a state of health it is all alike a part 
of my domain. Use this human experience to in- 
terpret God's relation to the universe. First, God 
is Spirit and transcends the universe. "He, and 
He alone, exists in and of Himself, * * * while 
the universe, His sole companion in existence, ex- 
ists simply and solely because of Him. He is the 
Creator; it is the creature. His is the will, and the 
universe is the response. In self-existence and 
creatorhood He stands transcendent." And, sec- 
ond, this transcendent Spirit is no absentee God, 
detached from the universe, a localized Deity 
dwelling in the sky, as still many hymns and 
prayers represent Him to be. "All opportunity 
to think of an infinitely distant home of God is 
crowded out, and it is by a practical necessity that 
we look upon Him as a pervading Presence. If 
we are to think of Him as anywhere, we are com- 
pelled to think of Him as everywhere." In this 
respect, as we have already pointed out, the scien- 
tific conception, as interpreted by Herbert Spen- 
cer, and the spiritual conception, as interpreted by 
the ancient Psalmist, are essentially one. The tes- 
timony of religious experience modern science 
confirms. C Lyman Abbott.) 



212 



THE HOSPITAL BULLETIN 



There are two great truths of universal import 
in this conversation. The first is this : The way 
to enter the kingdom of God is not so much by 
effort, not by acquiring great knowledge, as by 
response to the Spirit of God. There are two 
kingdoms — a kingdom of the flesh and a kingdom 
of the spirit ; a kingdom of the animal and a 
kingdom of the soul. Every man is born with 
power to respond to the impact of these two king- 
doms. Food, air, water, all kinds of natural pow- 
ers, beat in upon him from the world and develop 
his body if he will let them. Likewise, says Jesus, 
Divine forces beat in as winds upon man's soul 
to quicken his soul-life if he will let them. Man 
is meant to keep both sides of his nature open to 
these double influences from birth and let his life 
be developed in proper harmony. It was not 
many years ago when men said that during the 
first 15 or 20 years of a man's life, during child- 
hood and youth, let him be responsive to the fleshy 
influences only ; then suddenly bring the spiritual 
influences upon him with tremendous force, and 
let them pry open his heart and take it so as by 
force. This was the false idea that Bushnell 
fought so hard. It was contrary to nature. I lis 
contemporaries accused him of not believing the 
truth that a man is born into the kingdom from 
above. Bushnell answered, in substance, that he 
believed it with his whole heart even more than 
they did. 

"Only," he said, "it ought to be contemporane- 
ous with physical development. You immediately 
put the child under fleshy influences, and he is 
gradually adjusted to the natural kingdom; so, 
also, put him under spiritual influences and let 
them lift him up into the kingdom of God." 

And Bushnell was right. Today we are trying 
to rear children so that they shall be simultane- 
ouslv fed from both kingdoms. In the normal 
life these two processes develop side by side — the 
body fed from earth, the soul nourished from 
heaven. 

But how many men respond only to the im- 
pacts of earth and belong only to the earthly 
kingdom? How many men pass into old age 
hardly feeling one quickening, regenerating touch 
of those breezes that sweep the earth from the 
spirit world ? They are not always nor necessarily 
bad men. but they have nothing higher born with- 
in them than earthly forces can generate. They 
have felt the impact of the earth and air, of work 
and comradeship, and have sometimes risen high 



from earthly impellings. Nicodemus was just 
this type of man. He had been born, as is every 
man, with power to respond to the two kingdoms 
— the seen and the unseen, the human and the 
Divine. Jesus saw at a glance that he had lived 
entirely in the seen world and been shaped by its 
forces only. His idea of the kingdom was mate- 
rial. He was interested in miracles and theol- 
ogy — all the concrete, earthly sides of religion. 
His ideals never rose beyond prudence ; his as- 
pirations never soared above the earth or beat 
against the sky ; his nature had not throbbed and 
bounded to anything intenser than the thrills of 
earth. Xow, to Xicodemus. and to us all, Jesus 
says that just as a man is adjusted to the natural 
world and born into the power of the fleshy king- 
dom, not alone by efforts of his own, but by sub- 
mitting himself to the impact of the world forces, 
so a man is born into the kingdom of God by 
humbly opening his heart to the incoming of the 
Divine Spirit and letting it shape him into har- 
mony with the things of heaven. 

There is a Divine, heavenly, spirit force in this 
world. It is just as real as earthly forces. It is 
more real, for it rules them and is above them. It 
is the Spirit of God Himself. It is God — opera- 
tive, energizing, redeeming men. It is the soul of 
the universe, everywhere present. It is here, beat- 
ing against the human heart, as the ground beats 
against the feet or the winds against one's cheek. 
To get into this kingdom one who has lived only 
in the fleshy kingdom must open wide the win- 
dows of his heart, make the heart clean, pure and 
inviting, pray, live a life conducive to the Spirit's 
entrance, cheerish the Spirit when it comes, make 
the chief end of life to keep responsive to its 
touches, and thus let himself be born, regenerated, 
quickened from above. With the Spirit's en- 
trance new, heavenly powers will pulsate through 
our frames. Our souls will swell with refreshing 
currents. New visions will flash upon us far sur- 
passing earthly landscapes. New truths will fall 
into the mind far beyond man's finding. Ideals 
will spring up that burn like stars. Purposes will 
grow to find their consummation in other worlds. 
For, with the Spirit comes the consciousness of 
immortality. The kingdom of God is an eternal 
kingdom. To be born of it is to become one with 
its eternity. Peace will come, for peace is the gift 
of God. Life will bring forth new virtues, new 
beauties, new heroisms, new powers to love and 
suffer. We will live bv new laws and diviner mo- 






THE HOSPITAL BULLETIN 



213 



tives, lean on new arms, live with new friends, 
have our life in God. "Like an exotic plant in a 
temperate zone, the soul without God bears only 
leaves." With God it bears heavenly fruits and 
takes His likeness upon itself. 

This, then, is the way into the kingdom. Un- 
aided, man may go far, but for entrance into the 
full-orbed glory we must be born into it by the 
touch of the Divine Spirit from above. 

To be born from above — how we all need it ! 
— need to be made over even every day, need psy- 
chic cleansing, regenerating, lifting into higher 
life! How we need to be born again in our pur- 
poses ! How we need to have our loves exalted 
and purified, our emotions deepened and sancti- 
fied, our interests expanded, our hearts cleansed, 
our sins washed away by the Spirit's cleansing 
presence ! How we need enlargement of life, our 
lives transformed and transfigured by the glory 
of God's abiding presence ! How can we be long 
content to live in the small kingdom of the earth 
when the other kingdom, with its glories, lies just 
above and around us and stoops down to lift us 
up when we yield? We belong to the kingdom 
of God by nature. We have strayed from it, kept 
ourselves from its blessed fields. But it is ours if 
we will. Said Jesus, "Come ye blessed of My 
Father, inherit the kingdom prepared for you 
from the foundation of the world." 

Let us now look at the other and closely allied 
truth which Jesus emphasized in this conversa- 
tion. It has to do with the comprehension of re- 
ligious truth. He gives here a helpful and uni- 
versally true motto, a natural and unfailing way 
of approach to truth : "First earthly things, then 
heavenly." Nicodemus had been seriously trying 
to comprehend the new doctrines Jesus taught. 
He was a good man and really wanted to under- 
stand these doctrines, but they were too transcend- 
ent for him. We today cannot realize how tran- 
scendent Jesus' teachings were to an Israelite. 
Jesus sees Nicodemus' trouble, and says: "Nico- 
demus, you cannot understand these heavenly 
things until you have fulfilled their earthly re- 
quirements." That is, according to Jesus, it is 
not bv cold, abstract processes of reasoning that 
Nicodemus could get insight into the higher spir- 
itual laws, but by a process of living. He could 
not understand heavenly things until he was filled 
with an enthusiasm for Godlike life here on earth. 

It is a great truth. Earthly virtues are the 
paths over into heavenly truths. The virtues come 



first. We walk over into the meaning of the doc- 
trines of the kingdom by obeying its laws. "He 
that doeth the will of God shall learn of the doc- 
trines." If we want to understand the lofty things 
Jesus taught, we must walk with Him in lowly 
ways of love and duty. Forget your mental 
troubles and live in His Spirit, and the truths He 
taught will grow luminous. Sometimes the way 
to seek spiritual truth is not to make any special 
efforts to seek it, but by holy living prepare your- 
self to let it break in upon you of its own will. 
It will come when the heart is ready. None of 
the disciples understood Jesus' teaching during 
the first few months they followed Him. Instead 
of explaining His doctrines, He said: "You will 
hear when you have ears to hear," and set them 
to living His commandments. After a while the 
deep meaning and mystery of the truth came — 
silently, unsought, as the dawn comes. Children 
first learn to speak the language ; by and by, with 
the years, the meaning comes. If we live the 
Sermon on the Mount, by and by we can under- 
stand the last chapters of John — first the natural, 
then the spiritual ; first doing, then knowing ; first 
life, then its meaning; first earth, then heaven. 

Or we can put this same truth another way — 
spiritual vision depends on spiritual manhood. 
Moral enthusiasms must precede heavenly mys- 
teries. There is a beautiful verse in the Revela- 
tion which, in speaking of the heavenly music the 
poet heard in his vision, says, "But no man could 
learn that song excepting them which had been 
redeemed from the earth," which is only another 
way of saying that only the pure in heart can hear 
heavenly voices or see God. If we wish to see 
heavenly things, we must cultivate the eye of the 
soul — make it single, pure. Spiritual truths are 
revealed to the spiritual man. God is spirit, and 
they who would know Him must know Him in 
spirit and in truth. 

Who knows but that if we today would make 
our hearts as pure as were the hearts of prophets 
and disciples of old we might have such visions 
again of God in His world? I myself have an 
unfaltering conviction that if God's voice is not 
heard today as distinctly and gloriously as it was 
heard by the writers of the Bible, it is not because 
God is not trying to say just as great and as im- 
portant things to us, but because we are not re- 
ligiously sensitive enough to hear. I see no reason 
why Bibles should not be written today if men 
would only make themselves as spiritually sensi- 



214 



THE HOSPITAL BULLETIN 



tive to God's presence as men were in the older 
days. God is not absent, neither does He speak 
to one time and neglect another. If we see Him 
not today, it is not because He is not here, but 
because our vision is clouded. May it not be that 
when we have passed through this period of ma- 
terialism in which now we rush and strive, and 
turn again to the things of the soul and reach out 
for the higher life, new prophets shall arise and 
new books of God be written, and new psalms be 
sung, and there be open vision again of God's 
presence here on earth ? 

Or, to put it in still another way, one must enter 
into the spirit of a thing before he can understand 
it. The reason Nicodemus could not comprehend 
what Jesus said about the kingdom was because 
he was not in sympathy with it spiritually. So 
Jesus says to him: "It is vain for Me to try and 
explain the Divine mysteries of My kingdom, 
Nicodemus, while you have no sympathy with the 
kingdom itself." This is the heart of the matter. 
We cannot comprehend the beauties of Divine 
things until we enter into oneness with their pur- 
pose. We see the meaning of things according to 
the spirit that animates our searching. The artist 
looks at the landscape and sees a thousand beau- 
ties hid to common eyes. To enjoy music to its 
fullest extent we have to know its laws and make 
for ourselves poetic natures. In all things we 
have to bring ourselves up to the level of that 
which we should comprehend. The universe is 
full of the revealings of God. No man would 
dare hint at the thousands of even natural forces 
as vet unfelt and unseen — unfelt because we have 
not yet developed ourselves enough to feel. When 
we develop our mental sensitiveness up to a cer- 
tain point a new world of stars bursts in upon it 
or a Roentgen ray. One of the zests of living is 
the consciousness that as we grow in mental re- 
ceptiveness new and wonderful things out of the 
unseen world will flood our minds. So, too, as 
we learn to love spiritual things and become pos- 
sessed with a great enthusiasm for the kingdom of 
God, and go out into life looking and longing for 
God, and make our souls sensitive to Divine and 
holy things, there shall grow up within us an 
abiding sense of the nearness of the blessed Spirit 
presence, and secret mysteries of heaven shall be- 
gin to unroll their meaning before our eyes, and 
streams of power and plenty begin to roll in upon 
us out of unseen worlds, and all the earth begin 
to glow with the glorious presence of the Lord. 



First the trained and sympathetic heart, then the 
kingdom ; "first earthly things, then heavenly." 

We are fortunate enough to know that Nicode- 
mus followed these rules we have been studying 
and that they brought him into the kingdom. For, 
two years later, when the Jews would sentence 
Jesus without trial, we find Nicodemus pleading 
His cause, and, at the last, we find him, in his 
great devotion, doing honor to the dead body of 
the Lord ; .for, says John : 

"There came also Nicodemus (which at the 
first came to Jesus by night), and brought a mix- 
ture of myrrh and aloes, about a hundred-pound 
weight. Then took they the body of Jesus and 
wound it in linen clothes with the spices, as the 
manner of the Jews is when they bury." 

This was the truest indication that Nicodemus 
then understood the teachings of Christ, because 
his was a great sacrifice to give up his lordly sta- 
tion in the Jewish hierarchy of that clay and be- 
come a disciple of the Lord. 

"Wherever through the ages rise 
The altars of self-sacrifice, 
Where love its arms has opened wide 
Or man for man has calmly died, 
I see the same white wings outspread 
That hovered o'er the Master's head." 



ETIOLOGY OF NEPHRITIS. 



By John E. O'Neill, 
Senior Medical Student, 1910. 

In the discussion of a disease such as this, 
where oftentimes one particular form merges into 
the other, and where we frequently find as a con- 
sequence of this that the varieties of classifications 
are, to say the least, confusing, it will probably 
he better for our present purpose, from the stand- 
point of the etiology, to present merely a consid- 
eration of the three main clinical forms, namely, 
acute diffuse nephritis, chronic parenchymatous 
nephritis and chronic interstitial nephritis. 

Acute diffuse nephritis (known generally as 
"acute Bright's") is due, in practically all cases, 
to one of six causes, or possibly several of these 
acting together. They are: (1) cold and ex- 
posure, (2) poisons of the specific fevers, (3) 
toxic agents of a chemical nature, (4) pregnancy. 
(5) skin lesions and (6) trauma. 

As to age, it more often appears before than 



THE HOSPITAL BULLETIN 



21' 



after middle life ; and as for sex, males are more 
susceptible than females, particularly when en- 
gaged in occupations requiring exposure to cold 
and wet. 

Taking up these causes separately, the first 
(cold and exposure) is probably the most fre- 
quent. In the opinion of most authorities, cold 
of itself rarely produces marked renal disturb- 
ance, some predisposing cause being necessary, 
and such a predisposing cause, in the great ma- 
jority of cases, is alcoholism — either the habitual 
use of alcohol or the state of lowered resistance 
following a drinking bout. Quite a difference of 
opinion exists as to alcohol being solely respon- 
sible, one authority stating that "alcohol probably 
never excites an acute nephritis," whilst another 
asserts positively that "acute intoxication from 
beer drinking itself may cause an attack of acute 
nephritis." In the rare cases, where cold seems 
to be the only factor concerned, it may possibly 
be due to congestion ( the blood having been with- 
drawn from the peripheral circulation) or to the 
action of toxic substances retained in the circula- 
tion as a result of the lessened activity of the 
sweat glands. 

The next cause of acute nephritis — and a fre- 
quent one — is poisons of the specific fevers. By 
far the most common of these is scarlet fever, in 
which disease it may supervene during the height 
of the fever, or, rather, when the disease is at its 
worst, but more often it occurs in the second or 
third week of convalescence. Less commonly acute 
nephritis occurs in, or as a sequela; of, typhoid, 
measles, diphtheria, smallpox, chicken-pox, mala- 
ria, cholera, yellow fever, meningitis, and very 
rarely dysentery. It may be associated with syph- 
ilis and with acute tubercular lesions, particularly 
the former. Bradford states that probably many 
of the idiopathic cases, and even those ascribed to 
cold, may be of syphilitic origin. It may also oc- 
cur in septicemia and in acute tonsillitis, and is 
not uncommon in exudative erythema and the 
allied purpuric affections. 

The third cause mentioned above was toxic 
agents of a chemical nature. Here we meet with 
such substances as turpentine, cantharides, potas- 
sium chlorate and carbolic acid — substances 
which may bring about an acute congestion which 
sometimes terminates in nephritis. The excessive 
ingestion of highly acid, spiced or adulterated 
foods is certainly deserving of some considera- 
tion in this connection, some individuals being 



more susceptible than others. Ether anesthesia 
may occasionally cause renal inflammation. 

The next condition mentioned as being causa- 
tive of acute nephritis is pregnancy. The etiology 
of the nephritis of pregnancy is still undeter- 
mined, but is probably due to one of two factors — 
(a) compression of the renal veins or (b) the 
action of toxic products. That the former is the 
more probable of the two is evidenced by the fact 
that it occurs more often in primiparse than in 
multipara?, and is there found in the last months 
of pregnancy. 

An occasional cause of acute nephritis comes 
fifth on the list, being skin lesions. In these may 
be included burns, the nephritis being due to the 
taking up by the circulation of toxic or toxic-like 
substances from the detritus at the site of the 
burn. In certain chronic skin diseases acute 
nephritis is not infrequently an accompaniment. 

Sixth and last is trauma, using the term in a 
rather broad sense. Under this also may be in- 
cluded the extension of inflammatory products 
from below and from contiguous structures, as 
in psoas abscess. 

Coming now to the first of the two chronic 
forms, chronic parenchymatous nephritis, we find 
that it is due mainly to one of three causes : ( i ) 
following acute nephritis, (2) alcohol, (3) as a 
complication. As in acute nephritis, chronic pa- 
renchymatous is found more frequently in males 
than in females, and is met with most commonly 
in young adults. 

First, "following acute nephritis" — more fre- 
quently than is usually stated the disease has an 
insidious onset and occurs independently of any 
acute attack, but in most of these cases we find 
the fevers playing an important role. In this con- 
nection I. E. Atkinson and Thayer lay special 
stress upon malaria as a cause. It not infrequent- 
ly follows the acute nephritis of cold. 

The second causative factor mentioned was 
alcohol. There seems to be no doubt that alcohol 
may cause this form of the disease, although opin- 
ion seems to be somewhat reserved on the sub- 
ject. 

Lastly, as a complication. In chronic suppu- 
rative syphilis and tuberculosis parenchymatous 
nephritis is not uncommon, and is usually asso- 
ciated with amyloid disease. 

Probably the most interesting form of nephritis 
is the one about to be considered — chronic inter- 



2l6 



THE HOSPITAL BULLETIN 



stitial. The course leading to it may be grouped 
as follows: "(i) heredity, (2) syphilis, (3) over- 
eating, (4) alcohol, (5) secondary to arterio- 
sclerosis and (6) primary. Similarly to the other 
two, this form is also more frequently found in 
males than in females, and usually begins near 
middle life. 

Considering first heredity, this is a matter of 
some degree of importance, as in a remarkable 
family mentioned by Dickinson, in which a pro- 
nounced tendency to chronic Bright's disease oc- 
curred in four generations. Next comes syphilis. 
This is held by some to produce chronic Bright's 
disease, but probably in many cases it is rather 
due to the mercurial treatment. The third cause 
mentioned was overeating. The frequency of the 
disease in the better classes in America is sug- 
gestive, and Osier prefers to believe it to result 
from overeating rather than from alcoholic ex- 
cesses. It is quite possible in persons who habit- 
ually eat and drink too much, the work thrown on 
the liver is excessive, and the elaboration of cer- 
tain materials is so defective that, in their excre- 
tion from the general circulation, they irritate the 
kidneys. 

The fourth cause — and an important one — is 
alcohol. The continuous, and even moderate, use 
of alcohol for many years is a widespread cause 
of the disease, particularly in conjunction with 
other factors. 

Fifth on the list are those cases secondary to 
arteriosclerosis. This is by far the most com- 
mon form in America. It is seen in men over 40 
years of age who have worked hard, eaten freely 
and taken alcohol to excess. They are conspicu- 
ous examples of the "strenuous life," the inces- 
sant tension of which is first felt in the arteries. 

Finally, we consider the primary form, reserved 
until now because it is probably the most typical 
of the chronic diseases of the kidney. With renal 
sclerosis it is favored in origin and development 
by the anxieties, worries and high nervous ten- 
sion connected with modern business activity and 
social functions, the latter particularly acting 
their part among elderly ladies. It is chronic 
from the onset — a slow, creeping degeneration of 
the kidney substance, in many respects only an 
anticipation of the gradual changes which take 
place in the organ in extreme old age, aptly 
termed by Dr. Chew "the gray hairs of the kid- 
ney." 

2526 North Calvert street, Baltimore. 



THE MEETING OF THE SOUTHERN 

SURGICAL AND GYNECOLOGICAL 

ASSOCIATION. 



By Randolph Winslow, M.D. 
The twenty-second annual meeting of the 
Southern Surgical and Gynecological Association 
was held at Hot Springs, Va., on December 14, 
15 and 16. 1909. Hot Springs is a famous 
thermal resort, situated in Bath county, Virginia. 
It is reached via the Chesapeake & Ohio Rail- 
road, and one can make the trip without change 
by securing accommodations in the Pullman car 
from Baltimore. Hot Springs is not only a sum- 
mer resort, but it has become also a popular win- 
ter resort. It is situated in the Alleghany Moun- 
tains at an elevation of about 2500 feet above the 
sea, and derives its name from the fact that 
springs of hot water are found in this locality. 
These springs are very beneficial for rheumatic 
diseases, and many people seek their aid to rid 
themselves of rheumatic and gouty affections. 
The chief hotel is called the New Homestead, and 
is an enormous building said to contain 800 
rooms. It is a popular place for associations of 
various kinds to meet at, and therefore the South- 
ern Surgical and Gynecological Association, in- 
stead of meeting in some large city, held its twen- 
ty-second annual session at Hot Springs, the 
meeting being held at the New Homestead Hotel. 
A large number of prominent surgeons from the 
Atlantic to the Pacific Coast and from the Great 
Lakes to the Gulf of Mexico gathered together 
to discuss surgical and gynecological conditions. 
About 45 papers were presented, covering a very 
wide range of subjects. Dr. R. C. Coffey of Port- 
land, Ore., presented an elaborate experimental 
work on pancreatoenterostomy in an effort to 
solve the problem of how to make an anastomosis 
between the pancreas and the small intestine, 
where for some reason it may be necessary to re- 
move a portion of the pancreas or to circumvent 
an obstruction of the pancreatic duct. He has 
apparently solved the problem, but the method 
has not yet been applied to human beings. This 
article of Dr. Coffey's will be found published in 
Annals of Surgery for December, 1909, and is 
well worth a careful perusal. The subject of 
pancreatitis, both acute and chronic, claimed con- 
siderable attention and will also be one of the 
prominent matters discussed at the next meeting 
of the American Medical Association. It is in 



THE HOSPITAL BULLETIN 



217 



the line of advanced surgical thought that cases 
of chronic pancreatitis, whether due to obstruc- 
tion of the common bile duct or to infection of 
the pancreatic and bile ducts, is best treated by 
performing cholecystenterostomy in order to thor- 
oughly and permanently drain the bile passages 
into the small intestine. Our friend, Dr. Charles 
H. Mayo, delivered a very excellent illustrated 
lecture upon the diagnosis of exophthalmic goi- 
tre, or, as he prefers to call it, hyperthryoidism. 
The scope of this lecture was very similar to those 
that he delivered at the University of Maryland 
in November. His associate, Dr. Louis B. Wil- 
son, also gave an illustrated lecture upon hyper- 
nephromata. Of 38 cases of malignant tumors 
of the kidney removed at Mayo Clinic in the last 
10 years, 19 of them, or 50 per cent., were hyper- 
nephromata. This is, then, the most frequent 
malignant disease of the kidney, and until recent- 
ly it has been thought to be a comparatively rare 
affection. A paper of vast importance, based 
upon experimental and clinical evidence, was read 
by Dr. George W. Crile of Cleveland, Ohio, en- 
titled "Clinical and Experimental Research Into 
Nitrous Oxide and Ether Anesthesia." Dr. Crile 
demonstrated the great advantage of nitrous ox- 
ide and oxygen anesthesia over the methods now 
in use. Not only is the danger greatly lessened, 
but the time required for producing complete an- 
esthesia is also reduced to a minimum, being 
usually a minute and a half to two minutes. The 
patient wakes up promptly, and a few minutes 
after the withdrawal of the anesthetic, in posses- 
sion of all his mental faculties, and does not have 
subsequently the nausea and vomiting that so 
frequently accompany chloroform and ether nar- 
cosis. It requires, however, a special apparatus, 
and is at the present time rather more difficult to 
employ, as well as more expensive. The time is 
certainly coming when nitrous oxide will be ex- 
tensively used as a general anesthetic owing to its 
quickness of action, freedom from danger and 
absence from those distressing after-effects which 
accompany other forms of general anesthesia. 
Dr. F. C. Witherspoon of Butte, Mont., read a 
paper on "Acute Gastro-Mesenteric Ileus Follow- 
ing Operation for Ulcer of the Stomach." He 
gave the details of a case upon which he had per- 
formed posterior gastrostomy for ulcer of the 
stomaeh. The patient did well for nearly two 
weeks, and then began to vomit and show evi- 
dence of obstruction of the new outlet. The lower 



margin of the stomach was found to reach as low 
as the pelvic brim, and, in spite of ordinary meth- 
ods of treatment, the patient's condition grew 
progressively worse. He reopened the abdomen 
and found the anastomosis perfect, but the stom- 
ach greatly dilated, showing that drainage was 
not taking place. He therefore performed a gas- 
trostomy, by means of which, through a rubber 
tube, he was able to keep the stomach empty, and 
after eight days the stomach had regained its tone 
to such an extent that it was possible to remove 
the tube and permit feeding by mouth. The pa- 
tient made a good recovery. A very excellent 
presidential address was made by Dr. Stuart Mc- 
Guire of Richmond. Va.. on "Latent and Active 
Neurasthenia in Its Relation to Surgery." Dr. 
Walter C. G. Kirchner of St. Louis, Mo., read a 
paper on "The Treatment of Wounds of the 
Heart, with Report of Two Cases," one of which 
recovered and the other proved fatal. Several 
other cases were also mentioned by other gentle- 
men in the discussion of the paper. It is evident, 
therefore, that wounds of the heart are properly 
treated by surgical intervention, and that when 
this is done a very large proportion of recoveries 
will take place. Stab wounds are more favorable 
for recovery than are gunshot wounds. Dr. How- 
ard A. Kelly of Baltimore presented a paper, with 
beautiful illustrations by Max Broedel, on an ex- 
cision to expose the kidney, which is rather differ- 
ent from the one ordinarily employed. 

Dr. John Young Brown of St. Louis and Dr. 
Wm. Engelbach presented a very excellent illus- 
trated address upon the anatomic, pathologic and 
clinical studies of lesions involving the appendix 
and right ureter, with specal reference to dagno- 
sis and operative treatment, in which, by means of 
the ureteral sound and X-ray examination, a dif- 
ferentiation between diseases of the appendix and 
of the right ureter could be made. Dr. Roswell 
Park of Buffalo, N. Y., made an address upon the 
prevalence of cancer, which he says is certainly 
increasing at a remarkable rate of progress, as is 
well known. He entertains the view that cancer 
is a parasitic disease, though up to this time the 
parasite has not been discovered. Dr. Robert T. 
Morris of New York, in his characteristic and 
inimitable style, read a paper on the advantages 
of neglect in appendicitis operations, the chief 
point being to operate as quickly as possible, with 
as little traumatism of the abdominal structures 
as possible — the avoidance of irrigation of the 



218 



THE HOSPITAL BULLETIN 



abdominal cavity and of handling of the viscera, 
the employment of small drains, and, as he says. 
"You run whilst the pus runs." Circumscribed 
serous spinal meningitis was the subject of a 
paper presented by Dr. John C. Munro of Boston. 
Mass., a condition which appears to have been 
recognized in but a few cases, and which is gen- 
erally amenable to surgical treatment. Dr. Chas. 
A. L. Reed of Cincinnati, Ohio, contends for the 
performance of cecostomy instead of appendicos- 
tomy in cases of amebic disease of the intestines, 
or, indeed, of any septic process located in the 
large intestine, and it is also claimed by some that 
this route either through the appendix or through 
the cecum might be advantageously substituted 
for the rectum for the purpose of the instillation 
of normal salt solution instead of as is usually 
done by the rectum, and it also may be made use 
of as an avenue for the introduction of liquid food 
into the large intestine. 

Many other very interesting topics were dis- 
cussed and papers presented, amongst them one 
by the writer upon "Some Acute Abdominal Con- 
ditions in Infants," which was very well received 
and elicited ample discussion. The next meeting 
of the association will be held at Nashville. Tenn.. 
under the presidency of Dr. W. O. Roberts of 
Louisville, Kv. 



THE PROFESSORS OF SURGERY IN THE 
UNIVERSITY OF MARYLAND. 



By Randolph Wixslow, M.D., 
Professor of Surgery, University of Maryland. 



No. 5. — Christopher Johnston, M.D. 

In 1869 Professor Smith resigned the chair of 
surgery and was made professor of the surgery 
of the skeleton, and Dr. Christopher Johnston 
was elected professor of the principles and prac- 
tice of surgery. He was descended from Scotch 
ancestry, and was born in Baltimore September 
2~ , 1S22. His academic education was received 
at St. Mary's College, and he began the study of 
medicine in the office of Dr. John Buckler. He 
received the degree of M.D. at the University of 
Maryland in 1844, and soon thereafter visited Eu- 
rope and traveled extensively. From 1853 to 
1855 ne was again in Europe, and spent much 
time in the hospitals of Paris and Vienna. On 
his return he was elected lecturer on experimental 
physiology and microscopy. In 1857 he became 



professor of anatomy in the Baltimore College of 
Dental Surgery, which position he held until 
1864, when he was made professor of anatomy 
and physiology in the university. As stated above, 
in 1869 he succeeded Professor Smith in the chair 
of surgery and held this position until 1881, when 
he resigned and was made emeritus professor of 
surgery, which title he retained during the rest 
of his life. Dr. Johnston was a highly educated 
and cultured gentleman with a strong taste for 
scientific study and research. He was an accom- 
plished linguist, speaking several languages with 
fluency ; he had a fine command of the English 
language and was an exceedingly entertaining 
lecturer to those who had sufficient education to 
be able to appreciate his style, but to those who 
were deficient in education he was not a lucid or 
entertaining teacher. He was a skilled micro- 
scopist, and did in his early life much excellent 
scientific work in this direction, which attracted 
wide attention both in this country and abroad. 
One of his earliest papers was on the "Auditory 
Apparatus of the Mosquito," which was pub- 
lished in the London Quarterly Journal of Micro- 
scopical Science in 1855. He was not a prolific 
writer, but contributed a number of articles to 
scientific and medical journals, his most preten- 
tious work being an article upon "Plastic Sur- 
gery" in the Ashhurst International Encyclopedia 
of Surgery in 1881. He was a neat and painstak- 
ing surgeon, and gave special attention to detail 
and cosmetic effect. He was the first in Mary- 
land to perform complete removal of the upper 
jaw. He operated for exstrophy of the bladder, 
and had a large experience in tracheotomy for 
various conditions. After the battle of Gettys- 
burg he rendered valuable service to soldiers 
wounded in that sanguinary conflict, and this ap- 
peared to be the turning point in his career, as 
from that time he became widely known and es- 
teemed as a physician and surgeon in Baltimore, 
and for many years prior to his death was the 
leading physician of the city. Dr. Johnston was 
a tall, well-proportioned man of striking appear- 
ance. His head was large and covered with a 
full growth of reddish hair, and he also wore a 
full beard of similar color. He was very formal 
in his manners and often quaint of speech ; he 
possessed a wide fund of anecdote, and his ad- 
dresses were frequently enlivened with witty sal- 
lies. He was a man of the highest personal and 
professional integrity, and was a great ornament 



THE HOSPITAL BULLETIN 



219 



both to his profession and the university. He was 
president of the Medical and Chirurgical Faculty 
of Maryland, the Academy of Sciences and of 
many of the local societies of the city. He was 
also a member of the American Surgical Associa- 
tion and of various other national societies. He 
visited Europe five times, and added to his knowl- 
edge of his profession as well as to his general 
culture by the result of his observations on these 
occasions. He died on October 11, 1891, and 
although he had been for some time more or less 
removed from the activities of his profession, he 
was held in the highest esteem by his confreres 
and by the people. 



CORRESPONDENCE 

Cotabato, Mindanao, P. I., Nov. 1, 1909. 
The Hospital Bulletin Co., 

Baltimore, Md. : 

Gentlemen — A number of our alumni, now 
members of the Army Medical Corps, are serving 
tours of duty — of two years' duration — in these 
possessions, and it has occurred to me to mention 
them and their work as a possible source of inter- 
est to those of your readers who happen to have 
known them during 'varsity and hospital days. 

The Chief Surgeon of the Philippines Division, 
the senior medical officer who directs the policy 
of our department throughout the archipelago — 
a position involving considerable responsibilities — 
is Col. Louis W. Crampton of the class of '69. 
As he is on the staff of the commanding general, 
his headquarters are in Manila. 

Major Wm. F. Lewis of the class of '93 is the 
senior medical officer at Jolo, which, with its 
mixed command of cavalry, infantry and field 
artillery, is one of our largest and most important 
military posts. 

Another member of the same class is Major 
Jere B. Clayton, whose station is Zamboango, a 
most desirable station and the headquarters of 
this department (of Mindanao), where he has 
just brought to a successful conclusion a very try- 
ing campaign against an epidemic of Asiatic 
cholera. 

At Los Banos, up in Luzon, where the army 
has taken advantage of the natural hot springs 
existing there to establish a sanitarium for the 
treatment of rheumatic and other affections bene- 
fited by this type of hydrotherapy, we find Capt. 
Perry L. Boyer of the class of '99. 



The class of 1900 is represented by Capt. Chas. 
C. Billingslea, one of the fortunate few with sta- 
tion in Manila. 

W. L. Hart, 'o(5 — one of my classmates — is 
also, like myself, a recent arrival from the States, 
and has been assigned to duty at Cebu, a large 
exporting point. He writes me that he likes the 
station so well that he is hoping the authorities 
will forget him for at least a year. We both have 
rank in the junior grade, that of first lieutenant, 
but he will attain his captaincy in two and I in 
three years' service. 

In the matter of assignments I have no cause 
to complain. Here we have a good variety of 
interesting medical and surgical cases, and, aside 
from the professional viewpoint, a sojourn in 
Moroland, where the inhabitants are all disciples 
of Mohammed and an interesting people, occupy- 
ing one of the most beautiful and fertile islands 
in this group, is well worth while. 

My very best wishes for the success of Tin: 
Bulletin. 

Very truly yours, 

A. D. Tuttle, 
First Lieutenant. Medical Corps. 



THE PART THE UNIVERSITY OF MARY- 
LAND PLAYED IN THE OPHTHAL- 
M< >L< >GICAL DEVELOPMENT 
IN AMERICA. 

William Gibson, another eminent surgeon who 
thought and acted for himself, and who contrib- 
uted materially to ophthalmologic knowledge and 
practice (Hubbell, "The Development of Ophthal- 
mology in America"), was the successor to Physic 
in the chair of surgery in the University of Penn- 
sylvania, to which he was called in 1819. He was 
born in Baltimore in 1788, and died in Savannah, 
Ga., in 1868. He graduated in arts in t8o6 from 
Princeton College with high rank as a classical 
scholar. He then repaired to Edinburgh, where 
he studied medicine under John Bell, graduating 
in medicine from the university of the city in 1800. 
From there he went to London, where he studied 
for some time under Sir Charles Bell. From Lon- 
don Dr. Gibson returned to Baltimore, and was 
soon in successful practice. He was appointed 
professor of surgery in the medical department of 
the University of Maryland in 1812. He occupied 
this position till he removed to Philadelphia in 
1819. Flis connection with the University of Penn- 



220 



THE HOSPITAL BULLETIN 



sylvania continued until 1855, when he resigned. 
Dr. Gibson was the first to ligate the common iliac 
artery in 1812, but his greatest feat, a feat which 
made his name widely known, both in Europe and 
in this country, was the performance of Csesarean 
section twice on one woman, saving mother and 
child in both instances. His reputation as an ex- 
pert operator extended far and wide, and while at 
times his ill-temper betrayed him into unkind ex- 
pressions, yet he never failed to command the 
highest respect of most of his confreres. He was 
an able and impressive teacher, his characteristic 
qualities being clearness, accuracy and earnestness. 
He made no pretensions to eloquence. Dr. Gross 
in his sketch of him says: "He handled his knife 
with great skill, and was one of the foremost oper- 
ators of his day.'' Dr. Gibson made many contri- 
butions to the practice and literature of general 
surgery, and some to the surgery of the eye. His 
most noted literary production was his "Institutes 
and Practice of Surgery," the first edition of which 
was published in 1824 ; the last, the eighth, in 1850. 
The first volume of this work contains an excellent 
resume of the diseases of the eye and their treat- 
ment, in which is embodied the undoubted results 
of the experience and study of a man versed in the 
ophthalmology of his time. His discussion of 
cataract is especially authoritative. He was the 
first surgeon to perform the operation for con- 
vergent strabismus, which was afterward made so 
popular by Dieffenbach. Unfortunately, he did 
not record his operation in time to receive due 
credit for priority. Dr. M. D. Reese, in 1842, in 
his supplement to the "Surgical Dictionary" of 
Samuel Cooper (p. 127), refers to strabismus 
operation thus : "It appears from the 'Institutes 
of Surgery' that Professor Gibson attempted the 
cure of strabismus by dividing the recti muscles of 
the eye precisely as now practiced, some 20 years 
since in Baltimore. Soon after he repeated it un- 
successfully in Philadelphia in several cases, and 
was induced to abandon it by the unfavorable 
opinions expressed on the operation by Dr. Physic. 
I [e, however, inculcated the propriety of the oper- 
ation on his class many years since, and Dr. A. E. 
Ilosack of New York, then one of his pupils, dis- 
tinctly recollects Dr. Gibson's expressions of confi- 
dence that the operation would ultimately suc- 
ceed." 

Dr. Gibson himself, in the sixth edition of his 
"Institutes of Surgery," published in 1841, de- 
scribes in detail the operations which he performed 



in 1818, and also adds that on the advice of Dr. 
Physic he was led to abandon these experiments. 
His reference to the subject will be found on page 
375 of his work. 

In 182 1 he described an instrument for cutting 
to pieces the crystalline lens in all cases of cataract. 
It was a pair of scissors, thus described : So deli- 
cate as hardly to exceed, in size, the iris knife of 
Sir William Adams, and at the same time so strong 
ami sharp as to cut with ease the most solid and 
a impact lens and capsule, without injuring in the 
slightest degree any part of the eye. These scis- 
sors are formed on the principle of Mr. Willaston's 
scissors, used for common purposes, with the edge 
so constructed as to operate like a knife. On this 
account the instrument perforates the coats of the 
eye with the utmost facility, and when introduced 
the blades can be opened to a certain extent, so as 
to cut the lens to pieces without bruising it or any 
other part, the necessary effect of scissors as they 
are usually made. This instrument possesses an- 
other advantage — the lens is supported in its nat- 
ural situation during the operation by having one 
blade behind and the other before it, so that it may 
be cut to pieces, in situ, and its remains afterward 
forced, by the shut blades, into the anterior cham- 
ber, for dissolution. 

At the time Dr. Gibson suggested this instru- 
ment, dissolution of cataract had become a popu- 
lar method of operating through the influence of 
Saunders and Adams of London, and the scissors 
were offered as a substitute for needles, the use 
of which was frequently attended by dislocation of 
the lens into the vitreous humor. 

Dr. Gibson's originality was further illustrated 
by another method which he adopted for the ab- 
sorption of cataract. It consisted in passing a 
common sewing needle, slightly curved and armed 
with a single thread of silk, through the sclera 
about two lines from the cornea, through the 
opaque lens and sclera of the opposite side at a 
point corresponding to the one at which it was in- 
troduced, the pupil having been previously dilated 
with belladonna. The silk being drawn through 
and the ends cut off, a single thread was thus left 
passing through the ball of the eye and acting on 
the diseased lens in the manner of a seton. Dr. 
Gibson operated in this manner on three cases. In 
two no reaction or accident intervened, and at the 
end of 10 days, in both cases, the diseased lens had 
disappeared. The silk was then withdrawn and in 
a few davs the vision was restored. In a third case 






THE HOSPITAL BULLETIN 



221 



i;i which this operation was performed it failed in 
consequence of the iris being wounded and the 
thread was withdrawn at an early period because 
of inflammation. The wound of the iris was at- 
tributed to not using belladonna. 

Although Dr. Gibson's reputation rested upon 
his general surgical work, from the foregoing 
notations it can be readily seen that he was to some 
extent a pioneer in ophthalmic surgery, and had a 
keen insight into ocular surgery as it then existed. 



ABSTRACTS 

Constitutional Conditions Affecting Nasal 
Catarrh.. 

Dr. Charles W. Richardson ( Monthly Cyclo- 
pedia and Monthly Bulletin, October, 1909) de- 
sires to call particular attention to the subtle in- 
lluences that certain conditions, unattended with 
any organic change, exert upon the mucous mem- 
brane of the nose, throat, and even the bronchial 
mucous tract. The local manifestations of these 
disturbances are in the form of vascular changes 
in the turbinal tissues. He divides them into 
three groups : ( a ) Paroxysmal form of vaso- 
motor turgescence of the nasal mucosa, occurring 
occasionally at periods during the day, more fre- 
quently at night, (b) A more or less constant 
type of vasomoter turgescence of the nasal mu- 
cosa, which is most intense during the night. I c) 
A vasomoter turgescence of the nasal mucosa oc- 
curring at night, and which is attended with a 
similar condition in the bronchial tract, as evi- 
denced by coughing and wheezing. 

The etiology in each instance is essentially ner- 
vous, superinduced by unhygienic methods of liv- 
ing and working. They are the result of over- 
working the whole nervous system, which is fol- 
lowed by impairment of the harmony of action of 
the vasomoter system. 

The rational treatment of these cases is hygienic 
and the mildest of local washes and applications. 
Cauterization and turbinotomy have no part in 
the cure of these conditions, according to the 
author. 



Dr. Charles A. Wells, class of 1862, recently 
elected State Senator from Prince George's 
county, Maryland, was tendered a reception by 
the Democracy of Chillum, Bladensburg and Hy- 
attsville districts at Hyattsville November 13, 
1909. 



Dr. Henry Weinberger, class of 1908, superin- 
tendent of the Maryland Homeopathic Hospital, 
has resigned, the resignation to take effect De- 
cember 12, 1909, to accept a position on the staff 
of St. Gregory's Hospital, New York. 



Dr. J. Clement Clark, superintendent of Spring- 
field State Hospital, in his annual report to the 
board of governors reports that there are 537 male 
and 400 female patients in the institution, and 
whose general health is good. 



Dr. R. C. Massenburg of Towson is able to get 
about again, after a week's illness. 



Dr. and Mrs. J. Fred Adams, who spent the 
summer and early fall at their country home on 
the Rolling road, near Catonsville, have reopened 
their city home, 1314 N. Charles street, for the 
winter. 



The following alumni are located in New York 
city : 

Dr. J. Bissell Dougal, class of 1888, 49 W. 38th 
street. 

Dr. Robert F. Chapman, class of 1865, 121 \Y. 
1 20th street. 

Dr. William T. Dawson, class of 1880, 766 West 
End avenue. 

Dr. William A. E. McKee, class of 1883, 20S 
East 73d street. 

Dr. Edward L. Meierhof, class of 1881, 1140 
Madison avenue. 

Dr. George A. Taylor, class of 1890, 46 West 
36th street. 

Dr. J. Dubois Van Derlyn, class of 1894, 174 
East 71st street. 

Dr. Felix Villamil, class of 1903, 342 E. 30th 
street. 

Dr. Ejnar Hansen, class of 1904. 

Dr. Clarence Benson, Columbus Hospital. 

Dr. William W. Hala, class of 1905. 

Dr. Joseph A. Devlin, class of 1906, St. Francis 
Hospital. 



ITEMS 

Dr. Charles D. Baker, class of 1882, was born 
near Frederick City, Md., September 8, 1857. 
He received the degree of B.A. in 1879 and M.A. 
in 1882 from Lebanon Valley College, Annvide, 



222 



THE HOSPITAL BULLETIN 



Pa. He resides at Rolirersville, Washington 
county, Maryland. 



Dr.. William Hewson Baltzell, class of 1889, is 
a son of the late Dr. William Hewson Baltzell, 
class of 1843. He was born at Baltimore Janu- 
ary 23. 1858. From 1890 to 1893 he was a resi- 
dent surgeon in the Johns Hopkins Hospital. Un- 
til recent years he lived in Baltimore, but is now 
a resident of Wellesley, Mass. 



Dr. G. Irwin Barwick, class of 1894. was born 
in Kent county. Maryland. March 28. 1869. In 
1891 Western Maryland College confered the de- 
gree B.A. upon him and later the M.A. He re- 
sides at Kennedysville, Kent county. Maryland. 



Dr. Joseph Edward Beatty. class of 1861. of 
Baltimore, formerly of Middletown, Md. ; phy- 
sician and surgeon, ex-surgeon United States 
Army and a general practitioner of medicine for 
48 years, was born at Frederick City. Md., July 
11. 1839. In 1855 he graduated from Frederick 
Academy, and later entered the medical school 
of the University of Maryland, whence he gradu- 
ated in 1861. He immediately entered the United 
States service with the rank of assistant surgeon ; 
in 1862 he was promoted to surgeon, and in 1865 
he was made division surgeon of the Ninth Army 
Corps. Since the close of the war he has en- 
gaged in general practice, first in Middletown. 
then at Baltimore. In 1899 Dr. Beatty became a 
member of the Medical and Chirureical Facultv. 



Dr. Samuel Lee Magness, class of 1902, of Bal- 
timore, is a native of this city. He was born No- 
vember 27, 1877, and is a son of Mr. Moses N. 
Magness and Mary E. Chaney. his wife. His 
earlier education was obtained in a school at 
Wetheredville. Baltimore county, and private in- 
struction. Tn 1898 he matriculated in the medi- 
cal department of the Universitv of Maryland, 
and was graduated with the degree of M.D. in 
1902. After graduation he was appointed assist- 
ant resident physician, Bayview Hospital, where 
he served a year, since which time he has engaged 
in private practice in Baltimore. In 1005 he was 
elected professor of chemistry in the Baltimore 
University. On October 20, 1904. Dr. Magness 
married Miss Stella F. McConnell. 



dent of Baltimore. He was born in Prince George 
county October 6, 1844. In 1868 he graduated 
from the Maryland College of Pharmacy, now 
the pharmaceutical department of the University 
of Maryland, with the degree of Ph.G, and in 
1876 had the degree of M.D. conferred upon him 
by the medical department of the University of 
Marvland. 



Dr. Samuel Jones Belt, class of 1876, is a resi- 



Dr. Benjamin Robert Benson, class of 1873, 
is a general practitioner of medicine at Cockeys- 
ville, Md.. where he has been prominent in pro- 
fessional circles for more than 30 years. He is a 
native of Blackrock, Baltimore county. Maryland. 
He was born January 6, 1854, and is a son of 
Rev. Joshua L. Benson and Rachel Jane Miller 
Benson. His literary education was obtained in 
public schools in the Fifth district of Baltimore 
county and Milton Academy at Philopolis, Md. 
In 1870 he entered the medical department of the 
University of Marvland, and was graduated from 
there in 1873 with the degree of M.D. He then 
served a year's interneship in the hospital. At 
the expiration of this period he formed a copart- 
nership with Dr. C. Wells of Hampstead, Carroll 
county, Marvland. which relationship he main- 
tained until December. 1873. when he located at 
Bruceville, Carroll county, Maryland, where he 
remained until March 31. 1875. On April 1. 
1875, he opened an office at Cockeysville, Md.. 
where he has since lived and where he has come 
to be recognized as one of the leaders of the medi- 
cal profession of that part of the county. Dr. 
Benson has served four years as school trustee. 
He is a member of the Methodist Episcopal 
Church. He joined the Medical and Chirurgical 
Faculty in 1885. He is also a member of the Bal- 
timore County Medical Society. In 1877 Dr. 
Benson married Mary Elizabeth Aseneth Anna- 
cost of Waverly, Aid., by whom he has six chil- 
dren — Carroll Price, Beulah Miller, Benjamin 
Robert. Jr.. Clarence Erving, Emory Wilhide and 
Mattice Elizabeth Benson. He is a brother of 
Joshua Edward Benson, class of 1884. who was 
born in Baltimore county September 7, i860, and 
who also practices at Cockeysville. He has two 
sons in the medical profession and both gradu- 
ates of the medical department of the University 
of Maryland — Dr. Benjamin Robert, Jr.. class of 
1907, and Dr. Clarence Erving. class of 1909, at 
present a resident physician in Columbus Hos- 
pital, New York city. Dr. Benson has always 



THE HOSPITAL BULLETIN 



223 



had a warm spot in his heart for his alma mater, 
and is one of its staunchest and most loval friends. 



These alumni attended the meeting of the 
Maryland Psychiatric Society, held at Mount 
Hope Tuesday, January 4, 1910: Drs. Frank J. 
Flannery, J. Clement Clarke, Frank J. Keating, 
N. M. Owensby, W. F. Swartz and W. S. Cars- 
well. Dr. J. Clement Clarke was appointed to 
the committee on the after-care of the insane. 



Dr. Edward Warren, the son of Dr. William 
C. Warren, was born in Tyrrell county, North 
Carolina, in 1828. He received his literary edu- 
cation at the University of Virginia, and obtained 
the degree of M.D. from the same institution in 
1850, and a year later also at Jefferson Medical 
College, Philadelphia. He then began practice at 
Edenton, in his native State. He spent the year 
1854-1855 in Paris attending the hospitals there. 
He returned to Edenton in the latter year and re- 
sumed practice as the partner of his father. In 
1856 he gained the Fisk Fund Prize of the Rhode 
Island Medical Society for an essay on "The In- 
fluence of Pregnancy on the Development of 
Tubercular Phthisis." About this time he edited 
the Medical Journal of North Carolina. In i860, 
a vacancy having occurred in the medical faculty 
of the University of Maryland through the death 
of Prof. Charles Frick, he applied for and ob- 
tained the chair of materia medica and thera- 
peutics. In January, 1861, he founded a medical 
journal in Baltimore, called the Baltimore Jour- 
nal of Medicine. This was a bi-monthly, and only 
three numbers appeared. By that time the Civil 
War had begun, and Dr. Warren went South. 
Between 1861 and 1865 he held medical offices 
under the State of North Carolina and the Con- 
federate States, viz., Surgeon-General of the 
former and Medical Inspector of the Army of 
Northern Virginia in the latter. In 1863 he pub- 
lished at Richmond a i2mo entitled "Epitome of 
Practical Surgery for Field and Hospital." After 
the close of the war he returned to Baltimore and 
demanded the restoration of his chair at the uni- 
versity. This was refused on the grounds that 
he had voluntarily abandoned it, and though re- 
peatedly notified to return, he had declined to do 
so, and that his continued absence and the inter- 
ests of the school had rendered it necessary to 
fill so important a chair, to which, though the cir- 
cumstances had warranted earlier action, the fac- 



ulty had yet postponed making a permanent ap- 
pointment until the session of 1863-64 (Profes- 
sor McSherry being appointed). Although Dr. 
Warren indulged in some threats, he did not put 
them into execution, but sought revenge by 
founding a rival college. In furtherance of his 
design he had address to obtain liberal aid from 
the city and State, and large classes were at once 
obtained by a beneficiary system admitting dis- 
abled soldiers from the South at nominal rates. 
By these means he reorganized Washington Uni- 
versity, a former rival of this university, but sus- 
pended since 1851. From 1868 to 1870 he edited 
a semi-monthly medical journal called the Medi- 
cal Bulletin. In 1871, owing to differences of 
opinion as to the management of the affairs of his 
school, Dr. Warren resigned and joined with 
Drs. Byrd, Opie and others in founding another 
college, the College of Physicians and Surgeons, 
in which, as well as in the former, he occupied the 
chair of surgery. In 1873 ne sought and obtained 
an appointment in the Egyptian service and set 
out for Cairo. He remained in that country until 
1875, holding the rank of Surgeon-in-Chief of 
the War Department. In that year he suffered 
so much for ophthalmia that he was compelled to 
seek a furlough. He did not return to Egypt, but 
settled in Paris, where he practiced as a licentiate 
of the University of France. Dr. Warren was 
honored by the University of North Carolina 
with the degree of LL.D. In 1885 he published, 
under the form of a series of letters to Dr. John 
Morris of Baltimore, an interesting autobiog- 
raphy, "A Doctor's Experiences in Three Conti- 
nents." Dr. Warren was a fluent speaker and 
graceful writer. He died at Paris September 16, 
1893. (Historical Sketch, University of Mary- 
land, Cordell.) 



Dr. Marshall L. Price, class of 1903, is secre- 
tary to the State Board of Health of the Com- 
monwealth of Maryland. 



Dr. Watson S. Rankin, class of 1901, is secre- 
tary of the North Carolina State Board of Health. 



Dr. Charles Frederick Williams, class of 1899. 
is secretary of the South Carolina State Board of 
Health. 



Dr. A. A. Matthews, class of 1900, of Spokane, 



224 



THE HOSPITAL BULLETIN 



Wash., is surgeon to St. Luke's Hospital, Spo- 
kane. 



Miss Nettie Flannagan, formerly superintend- 
ent of the University Hospital Training School 
for Nurses, occupies the same position at St. 
Luke's Hospital, Spokane, Wash. 



The last regular meeting of the University of 
Maryland Medical Association was held in the 
amphitheater Tuesday, December 14, 1909, at 8.30 
P. M. The program was as follows : 

Symposium on nephritis: 

1. Etiology — Mr. O'Neal, class of 1910. 

2. Pathology — Dr. R. B. Hayes. 

3. Symptoms and diagnosis — Dr. C. W. 

McElfresh. 

4. Treatment — Dr. Joseph Gichner. 

The meeting was well attended and the papers 
were thoroughly enjoyed by those present. 

Dr. John T. O'Mara is president of this society, 
and Dr. S. Demarco of 1604 Linden avenue, Bal- 
timore, secretary. All are invited to these meet- 
ings. Visitors are welcome. The meeting night 
is the second Tuesday of each month. 



Dr. J. W. Williams made the presentation ad- 
dress upon the occasion of the presentation of the 
portrait of Dr. F. E. Chatard to the Medical and 
Chirurgical Faculty Tuesday, December 7, 1909. 



At the meeting of the Section on Clinical Medi- 
cine and Surgery, Baltimore City Medical Soci- 
ety, Medical and Chirurgical Hall, Friday, De- 
cember 3, 1909, Dr. Hiram Woods read a paper 
on "A Case of Serous Meningitis Following Oti- 
tis Media ; Operation ; Recovery ;" and Dr. A. G. 
Rytina, "The Spirocheta Pallida — Some of the 
Practical Benefits Resulting from Its Discovery. " 



The following of our alumni have been vice- 
presidents of the Medical and Chirurgical Fac- 
ulty : 

1848-1840 — Peregrine Wroth, class of 1841. 
1850-185 1 — Joel Hopkins, class of 1815, and 

Peregrine Wroth, class of 1841. 
1853-1854 — John Fornendin, class of 1823, and 

Peregrine Wroth. 
1854-1855— George C. M. Roberts, class of 1826; 

Samuel P. Smith, class of 18 17, 

and Joel Hopkins, class of 1815. 



1 855- 1 856— George C. M. Roberts and G. W. 

Miltenberger, class of 1840, and 

M. Diffenderfer, class of 1833. 
1856-1857 — P. Wroth, Samuel Smith and W. H. 

Davis, class of 1833. 
1857-1858 — William Waters, class of 1824; 

Frederick Dorsey, class of 1824, 

and Joel Hopkins. 
1858-1859 — Samuel Chew, class of 1829, and 

Samuel Handy, class of 1821. 
1871-1872 — C. H. Ohr, class of 1834, and Ed- 
ward Warren, professor of materia 

medica and therapeutics. 
1873-1874 — Samuel C. Chew, class of 1858, and 

H. M. Wilson, class of 1850. 
1874- 1875 — Prof. Francis T. Miles and James A. 

Steuart, class of 1850. 
1875-1876 — Christopher Johnston and J. C. 

Thorrias, class of 1854. 
1X7(1-1877 — P. C. Williams, class of 1851 ; James 

A. Steuart and Francis T. Miles. 
1 877- 1 878 — S. C. Chew and F. E. Chatard, class 

of 1861 ; Charles H. Jones, class of 

1851. 
1 878- 1 879 — J. C. Thomas and L. McLane Tiff- 
any, class of 1868. 
1879-1880— H. P. C. Wilson, class of 185 1, and 

James A. Steuart. 
1 880- 1 88 1— L. McLane Tiffany. 
1881-1882— A. H. Bayly, class of 1835, and I. E. 

Atkinson, class of 1865. 
1882-1883 — Thomas S. Latimer, class of 1861, 

and Richard McSherry, class of 

1880. 
1883-1884— J. S. Lynch, class of 1853. 
1884-1885— L. E. Atkinson. 
1885-1886 — E. C. Baldwin, class of 1844, and J. 

E. Michael, class of 1873. 
1887-1888 — Charles H. Jones and James Carey 

Thomas, class of 1854. 
1888-1889— J. E. Michael. 
1 889- 1 890 — T. A. Ashby, class of 1873, and C. G. 

W. Macgill, class of 1856. 
1890-1891 — George H. Rohe, class of 1873. 
1891-1892 — J. W. Humrichouse, class of 1873. 
1892-1893 — J. W. Downey, class of 1869. 
1893-1894 — John S. Fulton, class of 1881. 
1 894- 1 895 — Charles W. Jones. 
1896-1897 — Wilmer Brinton, class of 1876, and 

Randolph Winslow, class of 1873. 
1897- 1898 — W. F. A. Kemp, class of 1872. 
1 899- 1 900 — Samuel Theobald, class of 1867. 



THE HOSPITAL BULLETIN 



225 



1900-1901 — Samuel T. Earle, class of 1870, and 
J. B. R. Purnell, class of 1850. 

1902-1903 — Samuel T. Earle and Wilmer Brin- 
ton. 

1903-1904 — James M. Craighill, class of 1882. 

1904-1905 — Samuel T. Earle and Julius A. John- 
son, class of 1871. 

1905-1906 — Charles O'Donovan, class of 1881, 
and Thomas M. Chaney, class of 
1866. 

1906-1907 — William T. Watson, class of 1891. 

1907-1908 — Roger Brooke, class of 1887; Henry- 
L. P. Naylor, class of i860, and 
George Dobbin, class of 1894. 

1909-1910 — Compton Riely, class of 1897. 



At a special meeting of the Medical and Chi- 
rurgical Faculty, 121 1 Cathedral street, Thurs- 
day, December 16, 1909, Dr. N. R. Gorter read 
the "Report of the Committee on Pure-Food 
Law." 



At the annual meeting of the Baltimore City 
Medical Society, Tuesday, December 7, 1909, Dr. 
Charles W. Mitchell was elected vice-president. 
During the meeting a portrait of Dr. N. G. Kierle 
was presented to the Faculty by Dr. Harry Fried- 
enwald, and also a book by Dr. Kierle entitled 
"Studies in Rabies." Dr. Kierle was honored by 
his alma mater at the centennial commencement 
with the degree of Doctor of Science (honorary). 
Dr. Kierle has been a credit to his alma mater. 
His contributions to our knowledge of rabies has 
been of inestimable value to the medical pro- 
fession. 



Dr. A. M. Shipley has been made a member 
of the House of Delegates of the Medical and 
Chirurgical Faculty. 



Dr. Thomas J. Talbott has been made chief of 
the gynecological laboratory, Maryland Medical 



College. 



Dr. Albert Levy has been made chief of the 
physiological work at the Maryland Medical 
College. 



Dr. Eugene Kerr is occuping his new home at 
Glencoe, Md. 



Dr. R. B. Hayes has been made a member of 
the board of governors of the North Carolina So- 
ciety of Maryland. 



Dr. Nicholas L. Dashiell has removed to 2927 
St. Paul street, Baltimore, Md. 



The resident physicians of the University Hos- 
pital gave a dance Tuesday, January 5, 1910, at 
the Lyceum Parlors to the nurses of the hospital. 
This affair is known as the annual New- Year 
dance. Heretofore it has been held at the hospital. 



Dr. Isaac C. Dickson, class of 1897, is located 
at 3022 West North avenue, Baltimore, Md. 



Dr. James A. Zepp, class of 18S7, of 3050 West 
North avenue. Baltimore, Md., has retired from 
active practice. He has been succeeded by his 
nephew, Dr. Herbert E. Zepp, class of 1904. 



On December 27, 1909, the members of the 
Health Department, Baltimore, Md., tendered Dr. 
James Bosley, the Health Commissioner, a din- 
ner at the Hotel Caswell. This is the ninth an- 
nual dinner which has been given by the members 
of the department in honor of the Health Com- 
missioner. Dr. William Royal Stokes responded 
to a toast. Amongst our alumni present were 
Drs. T. W. Clark, George W. Hemmeter, R. A. 
Warner, H. K. Gorsuch, Henry H. Hahn, L. J. 
Turlington, C. T. Buckner, V. F. Kelly, H. W. 
Stoner, Marshall L. Price, W. P. Stubbs and M. 
G. Smith. 



Dr. George Wells, class of 1867, of Annapolis, 
Md., Clerk of the Anne Arundel Circuit Court, 
Chairman of the Democratic County Central 
Committee and many years leader of his party in 
the county, is ill with pneumonia. Dr. Wells is 
65 years of age, and though he has always been 
a man of strong constitution, fears are enter- 
tained as regards the outcome. Dr. Walton H. 
Hopkins is in attendance. 



Dr. Louis B. Henkel, Jr., is secretary of the 
Anne Arundel County Medical Society. 



Dr. Randolph Winslow read a paper, "Goitre," 
before the Anne Arundel County Medical Society 
at Carvel Hall Hotel, Annapolis, Md., Tuesday, 
January 11, 1910. 



2 2() 



THE HOSPITAL BULLETIN 



Dr. Herbert Harlan read an address, "Con- 
junctivitis — Its Causes, Prevention and Cure," 
before the annual meeting of the Anne Arundel 
County Medical Society January n, 1910. 



Dr. William Royal Stokes presented a paper 
entitled "Opsonins and the Opsonic Index" before 
the Anne Arundel County Medical Society Janu- 
ary 11, 1910. 



The will of Dr. Thomas P. Sappington of 
Unionville, Md., has been filed for probate. The 
testator bequeaths all of his property, except the 
house in Unionville in which he resided and the 
furniture contained therein, to his son, Dr. Clif- 
ford T. Sappington, and brother, Greenbury Sap- 
pington, as trustees, to collect the income from 
the "state and pay the proceeds therefrom, an- 
nually, one-third ro the testator's widow, one- 
third to his son, Dr. Clifford T. Sappington, and 
one-third to his daughter, Claire Sappington, wife 
of Dr. James Sappington of Libertytown, Fred- 
erick county. Upon the death of the widow the 
tr. st is to cease, and the executors, who are the 
same as the trustees, are to dispose of the estate 
as follows : To Dr. C. T. Sappington is to be given 
a 300-acre farm in Carroll county and a farm of 
about 100 acres between Libertytown and Maple- 
ville ; to the daughter, a farm of 200 acres near 
Mt. Airy. All other property is to be converted 
into cash and divided equally between the two 
children. Dr. Sappington, Sr., as well as Dr. 
Sappington, Jr., graduated from the medical de- 
partment of the University of Maryland. 



Dr. William Hand Browne, class of 1850, fell 
on the ice in front of Calvert Station, Baltimore, 
recently, while on his way to take a train for his 
home at Sherwood, and broke his left arm. His 
condition is reported as favorable. Dr. Browne 
is professor of Old English in the Johns Hopkins 
University and is one of our most distinguished 
alumni as well as one of the oldest living. 



Dr. E. G. Ballenger, class of 1901, recently 
paid Baltimore a hurried visit. Dr. Ballenger re- 
sides at Atlanta and is editor of the Journal-Rec- 
ord of Medicine. 



Dr. Harry Naylor, class of 1900, and Mrs. Nay- 
lor have returned from their wedding trip and 
are occupying their new home at Pikesville. 



MARRIAGES 

Dr. Louis Cotten Skinner, class of 1901, of 
Greenville, S. C, was married Wednesday even- 
ing, December 29, 1909, at the Methodist Episco- 
pal Church South, Oxford, N. C, to Miss Daisy 
Elizabeth Minor, daughter of Mrs. Richard Van 
I'.uren Minor of Oxford. After graduating, Dr. 
Skinner was for a short time a resident physician 
in the University Hospital, but was compelled to 
resign owing to ill-health. As a student he was 
very popular with the members of his class, and 
was an excellent student, being one of the honor 
men. He is a member of the Phi Sigma Kappa 
fraternity. 



Dr. Henry Alan Naylor, class of 1900, of 
Pikesville, Md., son of Dr. Henry L. P. Naylor, 
class of 1S60, of the same town, was married Fri- 
day, December 3, 1909, at Ascension Protestant 
Episcopal Church, Baltimore, to Miss Louise 
Requardt, daughter of Mrs. John J. Requardt of 
1520 Linden avenue, Baltimore. The ceremony 
was performed by Rev. Robert S. Coupland. 
Immediately after the ceremony Dr. and Mrs. 
Naylor left for New York, where they embarked 
for Jamaica. After their return they will reside 
at Sudbrook avenue, Pikesville. After gradu- 
ating. Dr. Naylor was for a year resident gynecol- 
ogist in the University Hospital. 



Dr. T. Morris Chaney, class of 1906, formerly 
of Chaney, Md., now of Old Fort, N. C, was mar- 
ried recently to Miss Myrtle McComless of Ashe- 
ville, N. C. 



DEATHS 

Dr. Thomas Pearre Sappington, class of 1869, 
one of the best-known physicians of Frederick 
county, died December 8, 1909, of Bright's dis- 
ease, aged 62. Dr. Sappington was born at 
LTnionville, Frederick county, Maryland, and was 
a son of the late Dr. Greenbury Ridgely Sapping- 
ton, class of 1843. He was graduated in medi- 
cine from the University of Maryland in 1869, 
and for over 40 years practiced his profession. 
He was widely known in his section and univer- 
sally respected. He is survived by a widow, for- 
merly Miss Emma Worman ; a son, Dr. Clifford 
Sappington, class of 1903, and a daughter, Mrs. 
James Coale Sappington, wife of Dr. James C. 
Sappington, clasr of 1900. 






THE HOSPITAL BULLETIN 

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Vol. V 



BALTIMORE, MD., FEBRUARY 15, 19 TO. 



No. 12 



REPORT OF NINE GOITRE CASES AND 

( )XE CASE OF ABSCESS OF 

THYROID GLAND. 



By A. Aldridge Matthews 

Spokane, Wash. 



M.D. 



There have been in the last 30 or 40 years great 
strides made in the surgical treatment of goitres. 
From a mortality of about 40 to 50 per cent, it 
lias been reduced to about 5 per cent., and some 
individual percentages have been reduced to ' _■ to 
1 per cent. (Kocher and Mayo.) 

The medical treatment for the goitre at present 
is not very satisfactory and nearlv always useless, 
but I do not mean to disapprove ot all medical 
treatments in these cases, for in many cases I 
think they should be given a medical course of 
treatment and see if they can be helped ; especially 
the severe exophthalmic cases always should be 
kept under observation and treated to get them 
in better condition before an operation. 

The operations practiced today for goitre are 
ligation of the superior thyroid arteries, enuclea- 
tion and partial excision. The dangers accom- 
panying this operation is the removal of too much 
or all of the gland, which could cause myxedema : 
injury or removal of the parathyroid bodies, and 
thereby tetany developing ; hemorrhage, infection 
and injury to the recurrent laryngeal nerve. The 
percentages of cure in exophthalmic goitres vary 
very much in different hands, but, as a whole, 
about (>o per cent, are cured, 25 per cent, improved 
and the remainder unimproved are suffering from 
relapses, and I am unfortunate enough to have a 
case which is suffering from a relapse ; at least 
she never entirely recovered, although was won- 
derfully improved, this being case No. 4, which 
I will take up later in more detail. 

The technique in operation — I will not go into 
detail, but will give a brief outline. The patient 
is placed in the reverse Treridelenberg position, 
previously having been prep' ;d for the opera- 



tion, and the neck is now again prepared, the 
transverse collar incision being used, passing 
through the skin and platisma muscle, the flap 
being dissected up. exposing the sterno-hyoid ana 
thyroid muscles, which are retracted back. These 
muscles are sometimes cut high up when a better 
view of the field of operation is wanted, but I 
have ni it found this necessary in any of these 
cases which 1 am reporting. The tumor is-'now 
plainly in view ; the capsule is split longitudinally 
and the gland removed. I always use drainage in 
all of my cases and an excessive drainage in my 
exophthalmic cases, the anesthetic used being al- 
ways ether. While it is advised by Kocher and 
others to use cocaine, \ have never been able to 
convince myself that it is as safe as a general 
anesthetic, and it is not as comfortable for the 
patient or the operator. We can hardly anes- 
thetize the field of a large goitre with less than 
one-half to one grain of cocaine. I have seen 
severe intoxications and very severe results arise 
from one-quarter of a grain. It is true these indi- 
viduals possibly have idiosyncrasies to the use of 
this drug, but bow can we tell which of these indi- 
viduals might be the one to have this idiosyn- 
crasy? I think that the records will show the 
ratio of deaths from cocaine to be greater than 
that of either anesthesia, especially in these cases. 
I think the surgeons of this country as a whole 
prefer the general anesthetic in preference to the 
local, for we can have a very much better view 
in the field of operation under a general anes- 
thetic, and do the work more easily and more 
rapidly. 

One very difficult thing to determine is how 
much gland to remove in the hyperthyroidism 
cases. After removing a certain portion of the 
gland, and our patient is not cured, but improved, 
that means that we did not remove enough gland, 
and a second operation is necessary, which should 
lead to a cure. We cannot be governed by the 
size of the gland, for we may have a very large 
gland with very little hyperthyroidism, or a hypo- 



228 



THE HOSPITAL BULLETIN 



thyroidism and a very small gland with much 
hyperthyroidism ; so the size of the gland has no 
special bearing in this matter, and one has to 
judge for himself in each individual case as to 
how much gland to leave and how much to take 
away. 

The first four of these cases were of the exoph- 
thalmic variety — one fibro-adenomatous, three 
cystitic and one parenchymatous in character — 
and I here submit a brief history of each of these 
cases. 

I wish to take this opportunity to thank Dr. E. 
L. Kimball for case Xo. 2, this case being under 
his service and we both being intimately asso- 
ciated. 

hi case Xo. 1, the only fatal case of this num- 
ber, I have often regretted that I operated, not 
that the outcome would have been any different 
from what it was, but I am afraid it hurried her 
death a little. I was not especially inclined to 
operate, but was urged into the matter by the con- 
sultation of two other physicians as being the 
only possible chance to save her life. Cases 2 and 
3 made perfect recoveries, and from recent reports 
they are well and enjoying good health. 

Case No. 4. after leaving the hospital, improved 
slowly for about two months, and then her con- 
dition began to reverse itself. I have had her un- 
der observation ever since the operation on ac- 
count of her slow recovery. Up until about the 
first of September she was improving, but since 
she is slowly relapsing into the old condition, and 
I have advised the removal of more of the gland, 
which she has consented to have done in two 
weeks if her condition does not improve by that 
time. On the 22d of September her pulse-rate 
was 95, the exophthalmic condition being quite 
noticeable, but by no means as marked as it was 
at the time of her operation. She also complains 
of having a watery diarrhea and attacks of vom- 
iting, which sometimes come on without warning. 
Her nervous condition is good, except that she 
complains of a little difficulty in sleeping. The 
right upper angle which I left has enlarged to 
about twenty times the size of the original piece 
I left at the operation. The left lobe is apparently 
in normal condition ; there is no enlargement at 
present, but at the time of operation it was of 
considerable size. 

Case Xo. 10, being a case of an abscess in thy- 
roid gland, which is quite unusual, and for that 



reason I wish to place it on record, there being no 
special interest otherwise in it. 

Case Xo. 1. — Airs. G., age 32, white, female, 
married, Jewess ; admitted to the hospital January 
2, 1905; pulse, 138; respiration, 28: temperature. 
99 ; family history negative. 

Past History. — Negative as regards her present 
trouble. 

Present Trouble. — Noticed a swelling on the in- 
terior part of the neck about 18 months ago, 
which gradually increased for about six months 
and then remained that size for a few months. 
During this time she was taking medicine and ap- 
plying the ointment prescribed to her by her fam- 
ily doctor. She did not know the nature of the 
medicine and she did not think it had any effect 
upon the tumor, which was at this time about the 
size of a large flat biscuit on either side of the 
median line of her neck. At present there is a 
large bilateral, pulsating tumor about the size of 
a half grape fruit on either side, with large pul- 
sating veins on the external surface, and a decided 
thrill which can be felt and heard over and around 
this tumor. 

The eyes protruded greatly, and her sight is 
considerably impaired, being unable to see well 
at short range. She complained of great weak- 
ness, which has been becoming gradually worse 
for the past three months, and is not able to navi- 
gate without help, and is completely exhausted 
when attempting to make the least exertion. She 
complains of palpitation of the heart and a feeling 
as though she were going to faint. When exam- 
ining the heart I found it very irregular at times, 
pulse-rate 145 and very compressible. Has had 
attacks of gastric crisis, in which she would vomit 
two or three days at a time, of an expulsive nature. 
She has had two of these attacks, but has vomited 
a number of times at intervals. Bowels have been 
quite loose, moving a number of times a day. This 
condition she thinks is becoming worse, and has- 
been annoying her more or less for the last two 
months. The skin is very much pigmented and 
clammy. She also has considerable edema of her 
lower extremities. She is extremely nervous, un- 
able to feed herself, and at times twitching and 
jerking almost as though she has an attack of 
chorea. She has not menstruated for the past 
eight months, and was very irregular for some 
time previous to that. 

Operation. — February 2. A. M. Transverse 
incision ; very vascular ; many tortuous, large ves- 



THE HOSPITAL BULLETIN 



229 






sels matted around and through the gland. I re- 
moved the right lobe of the gland and about one- 
half of the left. After securing all bleeding points 
in the field of operation the wound was drained 
thoroughly and partially closed. The patient was 
given an infusion of normal salt solution, 700 c. c, 
before awakening, and this was repeated by the 
rectum in eight hours. She only retained part of 
the enema, and again by the rectum m the follow- 
ing eight hours, which was promptly rejected. 
Morphine was administered hypodermically when 
necessary to allay restlessness ; also atrophine, 
grain 1/100, was given hypodermically every 
eight hours for three doses following the opera- 
tion. The patient's condition was favorable up 
until about the twentieth hour, when the condi- 
tion became suddenly markedly worse, tempara- 
ture gradually rising from the time of operation, 
also pulse-rate increasing, and her general con- 
dition becoming more and more serious until 
death, which occurred about the thirtieth hour 
following the operation. Three hours before 
death the pulse-rate was 200, respiration 60, tem- 
perature over 103 . 

Case No. 2. — Mrs. V. V. C. ; September 28, 
1904; white, female, married; occupation, house- 
wife. Family history negative, with the exception 
that her paternal grandmother died of supposedly 
tuberculosis. Past history negative, with the ex- 
ception of having an attack of nervous prostration 
about three years ago which lasted several weeks. 
Menstruation period regular up until last June, 
and since that time she has not menstruated. 

Present History. — About three years ago, while 
having a dress fitted, she noticed a slight swelling 
in the front part of her neck. This swelling in- 
creased very rapidly for the next three months ; 
then she tried a goitre cure, which was an oint- 
ment and a tablet, and the tumor disappeared to 
a considerable extent. She took the full course 
of treatment, and while using this treatment she 
developed diarrhea, which has been more or less 
troublesome ever since. About this same time 
she noticed that the heart throbbed, and would 
jerk, as she expressed it. She claimed that when 
she first noticed the tumor that her heart beat 
fast and throbbed at times. She has lost weight 
gradually for the past three years, and this loss 
of weight has been more in the last year than the 
preceding two ; also noticed that her eyes pro- 
truded about two years ago, which she attributed 
to vomiting, as she had frequent attacks. Suf- 



fered considerably with headache, always accom- 
panied with vomiting spells. Headaches would 
last several hours and usually on the left side in 
the temporal region, and at this time the vomiting 
spells were worse than at any other. She has 
never been able to relieve these headaches with 
medicine, especially when the pain was on the left 
side. Sometimes medicine would relieve to a de- 
gree when the pain was located on the right side. 

Complains of great shortness of breath for the 
past three months, and this condition is becoming 
more annoying all the time. Her eyes protrude 
very much, the left more than the right; cannot 
bear strong light, and the eyeball is sensitive to 
the touch. 

Physical Examination. — Patient nervous and 
fidgety ; expression that of a staring one ; eyes 
protruding, sclera showing below the upper lid 
when looking straight ahead ; some fullness and 
edema around the eyes ; the eyelids do not follow 
the eyeball as they should ; they respond slowly 
when the patient looks downwards; pulse 114, 
easily compressible, but her arteries seem to be in 
good condition. There is marked pulsation in 
vessels of the neck. In front on either side of the 
median line are two distinct growths — the one on 
the right side about the size of a split orange ; on 
the left side about one-third the size of the former, 
and moves up and down when swallowing. Sen- 
sation to the touch is that of firm elastic mass, 
which pulsates to some extent, and a slight bruit 
can be felt on the left side. The right and larger 
lobe extends as high up as the thyroid cartilege 
and as low down as the sterno-clavicular articu- 
lation. With a stethoscope can be heard a stenotic 
blowing sound on the right side, which is possibly 
due to pressure on the large vessels of the neck. 
The same can be heard on the left side, but not so 
plainly. The heart _is considerably dilated, and 
in placing the hand over the cardiac area can be 
felt a tumultuous movement, apparently missing 
beats from time to time. Placing the stethoscope 
over the cardiac area I find the heart to be very 
irregular, with a galloping motion, and this ir- 
regularity is very much increased by a little ex- 
ertion. 

Operation. — The transverse incision is made, 
the field of operation being a vascular one ; 
numerous tortuous, dilated vessels around and 
through the gland ; the capsule is split ; the right 
lobe removed and the greater part of the left. 

This patient made a very satisfactory recovery. 



2 3° 



THE HOSPITAL BULLETIN 



leaving the hospital on the twenty-eighth dav 
after the operation, the maximum temperature 1 ic- 
ing 102°, the maximum pulse-rate 120. 

Case Xo. 3. — Mrs. C. M. ; April 12, 1909; age 
27, white, female, married : occupation, house- 
wife. Family history negative, with the excep- 
tion that the female members of the family are of 
a rather nervous character. Past history nega- 
tive. 

In regard to present trouble, she noticed first 
about three months ago a swelling in the front 
part of her neck, and has been quite nervous for 
the past few months; also complained that her 
heart and stomach have been giving her much 
trouble. After being annoyed with tiiis condition 
for some time she called on her family physician. 
Dr. Snyder of Davenport, who recognized her 
condition and brought her here for treatment. 
1 ler facial expression was one of fright, her eyes 
protruding, and she was very nervous; had been 
unable to sleep and had quite a tremor of her 
hands, a general condition of unrest and nervous- 
ness. She complained of great weakness and 
shortness of breath upon the slightest exertion; 
tachycardia well marked; pulse rate 120. She 
complained constantly of a sensation of heat ail 
over her body; perspired freely. This was more 
marked if she exercised or pretended to move 
about. She vomited frequently, and at times had 
a craving for certain foods, and one thing espe- 
cially which she craved was raw tomatoes. Bowels 
quite loose, but no diarrhea. 

Upon examining the neck I found a diffuse en- 
largement on both sides of the neck, the whole 
gland being involved. It had a firm feeling, and 
could detect a marked thrill, which was percep- 
tible to both the touch and ear. There was a great 
increase in vascularity, and the veins pulsated and 
w ere much distended. The patient I kept under 
observation for several days, giving her sedatives, 
etc.. but with no result. 

Operation. — April 13, 1909. Made transverse 
incision down to capsule of the gland, which I 
opened longitudinally, and did the operation rec- 
ommended by Ferguson, removing